Understanding compliance to an antibiotic prescribing policy: Perspectives of policymakers and prescribers

Background: Antibiotic stewardship programs have been shown to reduce inappropriate institutional antibiotic use. There is no consensus on the strategies, e.g. formulary restrictions, that best improve appropriate use and reduce misuse of antibiotics. Aim: To identify facilitators and barriers to compliance with an institutional antibiotic prescribing policy and to compare policymakers' perceptions about the facilitators and barriers that infl uence compliance with those held by prescribers. Method: 5 antimicrobial stewardship committee members (policymakers) and 15 prescribers from a large Sydney hospital participated in a semi-structured interview. To gauge prescribers' knowledge of the institutional antibiotic policy, case scenarios were included in the interviews with prescribers. Interviews were continued until data saturation was reached. Recurrent themes were analysed and interpreted in terms of a well-known conceptual framework of barriers to physician adherence to guidelines. Results: Antimicrobial stewardship committee members identifi ed lack of knowledge as the main barrier to compliance with the antibiotic prescribing policy. Despite reporting that they were aware of and agreed with the antibiotic prescribing policy, most prescribers did not comply with the policy and referred to clinical information sources when completing the case scenarios. Organisational hierarchies were frequently reported as a barrier by both participant groups. While prescribers considered inapplicability of the antibiotic prescribing policy as an important barrier, antimicrobial stewardship committee members attributed non-compliance to the policy to prescriber autonomy and personal experience. Conclusion: We identifi ed several barriers to compliance with the antibiotic prescribing policy, such as poor knowledge of policy specifi cs and medical hierarchies. Involving prescribers in policy development, giving them feedback about their prescribing, and improving existing collaboration and decision support platforms may further improve judicious antibiotic use.