To address the rise of antibiotic-resistant pathogens—so-called “superbugs”—primary care physicians in cities throughout the country favor education, both for themselves and their patients, research reveals. However, these physicians are wary about strategies that would track and report antibiotic prescribing practices.
Antibiotic use in outpatient health care settings, such as primary care offices and emergency rooms, represents the majority of dollars spent on antibiotics for human health care in the United States. Experts have determined that at least 30 percent of those prescriptions are unnecessary, such as when antibiotics are prescribed for viral infections such as bronchitis or colds, which do not respond to these drugs.
Because any use of antibiotics accelerates resistance, public health advocates are seeking ways to reduce unnecessary prescriptions. And, as preliminary studies have shown high levels of antibiotic use among COVID-19 patients during the pandemic, such efforts have never been more important. In June, the World Health Organization underscored the urgent need to minimize inappropriate antibiotic use during the pandemic, warning that it will only fuel discouraging trends of antibiotic resistance globally.
Primary care physicians, including those specializing in pediatrics, internal medicine, and family practice, account for the largest share of outpatient antibiotic prescribing in the U.S. This makes them key stakeholders to engage on implementing antibiotic stewardship efforts. Before the coronavirus pandemic, The Pew Charitable Trusts and the American Medical Association conducted focus groups with physicians in Chicago, Los Angeles, Philadelphia, and Birmingham, Alabama, to assess perceptions about antibiotic resistance and better understand the barriers to effective stewardship of these medications. The results were published in the peer-reviewed journal BMJ Open on July 15.
Several key themes emerged, including:
Drivers of inappropriate prescribing
The focus group results show that primary care physicians would welcome patient educational materials and trainings for physicians on how to talk about the threat of antibiotic resistance and the need to use these critical therapies wisely. However, their perceptions on the relative importance of antibiotic resistance as a public health issue and their own role in inappropriate prescribing, along with their resistance to tracking and reporting prescribing patterns, present barriers to increased implementation of outpatient stewardship activities.
COVID-19 provides a stark reminder of the numerous consequences when a public health crisis hits and there are limited or no effective treatments available. Understanding barriers to appropriate antibiotic prescribing can help health care stakeholders identify and prioritize policies that can help preserve the effectiveness of existing antibiotics and save lives. For example, tracking and reporting prescribing patterns are essential elements of outpatient antibiotic stewardship. This study suggests that, for physicians to find these activities useful, they would need to be incorporated into an accurate, fair, and meaningful feedback mechanism relevant to their everyday practice. In support of this idea, Pew is exploring policies to track antibiotic use for a range of conditions. Over time, that work could show physicians where they stand in relationship to their peers, and where there is room for improvement.
David Hyun, M.D., is a senior officer, and Rachel Zetts, M.P.H., is an officer with The Pew Charitable Trusts’ antibiotic resistance project. Andrea Garcia, J.D., M.P.H., is the director for Science, Medicine, & Public Health at the American Medical Association.