Merlo Gregory, Hall Lisa, Magin Parker, Tapley Amanda, Mulquiney Katie J, Fielding Alison, Davey Andrew, Davies Joshua, van Driel Mieke
School of Public Health, The University of Queensland, Brisbane, QLD, Australia.
Healthcare Improvement Unit, Clinical Excellence Queensland, Brisbane, QLD, Australia.
Appl Health Econ Health Policy. 2025 Mar;23(2):311-317. doi: 10.1007/s40258-025-00944-1. Epub 2025 Jan 24.
Antimicrobial resistance is a global emergency related to overprescribing of antibiotics. Few studies have explored how prescribing behaviours may change as the consequence of changing resistance. Understanding how contextual factors influence antibiotic prescribing will facilitate improved communication strategies to promote appropriate antibiotic prescribing. We aimed to develop and conduct a discrete choice experiment (DCE) to measure how contextual factors influence intended antibiotic prescribing of general practitioner (GP) registrars.
Factors included as attributes in the DCE were level of antibiotic resistance, requirement for an authority to prescribe, existence of a Practice Incentives Program (PIP) for low prescribing and supervisor support for low prescribing. The survey was administered in an online format for GP registrars undergoing training between 2020 and 2021. Regression analysis using a conditional logit model with interaction effects was used on the basis of the assumptions of independence of irrelevant alternatives, independence of error terms and no preference heterogeneity.
In total, 617 unique respondents answered at least one choice set question. Respondents showed significant preference for avoiding prescribing antibiotics when antibiotic resistance was 25-35% or 40-60% compared with 5-8%. There was also a significant preference for avoiding prescribing when an authority to prescribe was required, or when there was supervisory support of low antibiotic prescribing. In the main effects analysis, respondents were significantly less likely to choose a prescribing option if there was a PIP; however, when interaction effects were included in the regression analysis there was a significant interaction between PIP and resistance rates, but the preference weights for PIP was no longer significant.
Knowledge about community resistance impacts the stated intention of GP registrars to prescribe antibiotics. The use of the DCE may have made it possible to determine factors influencing prescribing that would not be detected using other survey methods. These findings provide guidance for producing, explaining and communicating issues regarding antibiotic prescribing to GP registrars.
抗生素耐药性是一个与抗生素过度处方相关的全球紧急情况。很少有研究探讨随着耐药性的变化，处方行为可能如何改变。了解背景因素如何影响抗生素处方将有助于改进沟通策略，以促进合理的抗生素处方。我们旨在开展并进行一项离散选择实验（DCE），以衡量背景因素如何影响全科医生（GP）注册实习生的预期抗生素处方。
作为DCE属性纳入的因素包括抗生素耐药水平、处方授权要求、低处方量的实践激励计划（PIP）的存在以及低处方量的上级支持。该调查以在线形式对2020年至2021年期间接受培训的GP注册实习生进行。基于无关替代品独立性、误差项独立性和无偏好异质性的假设，使用具有交互效应的条件logit模型进行回归分析。
共有617名不同的受访者回答了至少一个选择集问题。与5%-8%相比，当抗生素耐药率为25%-35%或40%-60%时，受访者表现出明显倾向于避免开具抗生素处方。当需要处方授权或有低抗生素处方的上级支持时，也有明显的避免处方倾向。在主效应分析中，如果存在PIP，受访者选择处方选项的可能性显著降低；然而，当回归分析中纳入交互效应时，PIP与耐药率之间存在显著交互作用，但PIP的偏好权重不再显著。
关于社区耐药性的知识会影响GP注册实习生开具抗生素处方的既定意图。DCE的使用可能使确定影响处方的因素成为可能，而这些因素使用其他调查方法无法检测到。这些发现为向GP注册实习生提出、解释和传达有关抗生素处方的问题提供了指导。
