What do physicians think about evidence-based antibiotic use in critical care? A survey of Australian intensivists and infectious disease practitioners

V. Sintchenko, J. R. Iredell, G. L. Gilbert, E. Coiera

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: The analysis of factors that influence prescribing decisions is increasingly important. Antibiotic use is often based on limited evidence and lack of information about clinical decision-making processes is an important obstacle to improving antibiotic utilization. Aims: To compare the attitudes of intensive care unit practitioners (ICUP) and infectious disease practitioners (IDP) to antibiotic use and to the evidence-based information support. Method: A postal survey conducted between March and July 2000 of ICUP and IDP representing all States and Territories in Australia. Results: One hundred and fifty-three of 224 clinicians returned the questionnaire (68.3% response rate). In choosing an antibiotic, IDP placed significantly more weight than ICUP on the in vitro susceptibility of the pathogen (P = 0.001), antibiotic cost (P = 0.05) and possible development of antibiotic resistance (P = 0.007). More than 95% of both groups believed that unit-specific antibiotic susceptibility of endemic pathogens was an essential factor in rational prescribing, but only 68.5% of IDP and 38.7% of ICUP use microbiology laboratory databases. When in doubt about appropriate antibiotic use, 63.8% of ICUP seek and 76.3% usually follow the advice of IDP. Both groups agree that published antibiotic guidelines are useful, but IDP were more likely to consult them. ICUP were more likely to believe that guidelines are used to control clinicians rather than to improve quality of care (P = 0.001). A greater proportion of IDP (71.2%) than ICUP (52.5%) believed that antibiotic prescribing in their intensive care unit (ICU) was evidence based but most (91.8% and 86.9%, respectively) agreed that it should be. Conclusions: Australian clinicians have positive views about evidence-based prescribing and antibiotic guidelines. However, there are clinically significant differences in prescribing behaviour between ICUP and IDP. These may be explained by different disease spectra managed by each group or different cultures, training and/or cognitive styles. Improvements in the understanding of physicians' information and decision support needs are required to strengthen evidence-based prescribing.

LanguageEnglish
Pages462-469
Number of pages8
JournalInternal Medicine Journal
Volume31
Issue number8
DOIs
Publication statusPublished - 2001
Externally publishedYes

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Critical Care
Communicable Diseases
Intensive Care Units
Anti-Bacterial Agents
Physicians
Guidelines
Surveys and Questionnaires
Quality of Health Care
Microbial Drug Resistance
Microbiology
Statistical Factor Analysis
Databases
Weights and Measures
Costs and Cost Analysis

Keywords

  • Antibiotic prescribing
  • Clinical practice
  • Critical care
  • Evidence-based health care
  • Infectious disease

Cite this

@article{4ee33ac6757b4ce1b98fe773b053c106,
title = "What do physicians think about evidence-based antibiotic use in critical care? A survey of Australian intensivists and infectious disease practitioners",
abstract = "Background: The analysis of factors that influence prescribing decisions is increasingly important. Antibiotic use is often based on limited evidence and lack of information about clinical decision-making processes is an important obstacle to improving antibiotic utilization. Aims: To compare the attitudes of intensive care unit practitioners (ICUP) and infectious disease practitioners (IDP) to antibiotic use and to the evidence-based information support. Method: A postal survey conducted between March and July 2000 of ICUP and IDP representing all States and Territories in Australia. Results: One hundred and fifty-three of 224 clinicians returned the questionnaire (68.3{\%} response rate). In choosing an antibiotic, IDP placed significantly more weight than ICUP on the in vitro susceptibility of the pathogen (P = 0.001), antibiotic cost (P = 0.05) and possible development of antibiotic resistance (P = 0.007). More than 95{\%} of both groups believed that unit-specific antibiotic susceptibility of endemic pathogens was an essential factor in rational prescribing, but only 68.5{\%} of IDP and 38.7{\%} of ICUP use microbiology laboratory databases. When in doubt about appropriate antibiotic use, 63.8{\%} of ICUP seek and 76.3{\%} usually follow the advice of IDP. Both groups agree that published antibiotic guidelines are useful, but IDP were more likely to consult them. ICUP were more likely to believe that guidelines are used to control clinicians rather than to improve quality of care (P = 0.001). A greater proportion of IDP (71.2{\%}) than ICUP (52.5{\%}) believed that antibiotic prescribing in their intensive care unit (ICU) was evidence based but most (91.8{\%} and 86.9{\%}, respectively) agreed that it should be. Conclusions: Australian clinicians have positive views about evidence-based prescribing and antibiotic guidelines. However, there are clinically significant differences in prescribing behaviour between ICUP and IDP. These may be explained by different disease spectra managed by each group or different cultures, training and/or cognitive styles. Improvements in the understanding of physicians' information and decision support needs are required to strengthen evidence-based prescribing.",
keywords = "Antibiotic prescribing, Clinical practice, Critical care, Evidence-based health care, Infectious disease",
author = "V. Sintchenko and Iredell, {J. R.} and Gilbert, {G. L.} and E. Coiera",
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What do physicians think about evidence-based antibiotic use in critical care? A survey of Australian intensivists and infectious disease practitioners. / Sintchenko, V.; Iredell, J. R.; Gilbert, G. L.; Coiera, E.

In: Internal Medicine Journal, Vol. 31, No. 8, 2001, p. 462-469.

Research output: Contribution to journalArticleResearchpeer-review

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