What factors affect family practitioners in the prescription of antibiotics for respiratory tract infections in Malta?

Abstract

1. Reason for Research Antibiotic resistance by bacteria is an increasing problem and one major contribution to this is inappropriate antibiotic prescribing. Several international studies have focused on identifying the causes of overprescribing. Local studies have shown the reasons for encounter but did not look into what influences the practitioners working in the Maltese islands. This seeks to identify those patient, clinical and doctor characteristics that affect antibiotic prescribing.

2. Method The study is based on a questionnaire survey where three hundred and twenty six questionnaires were posted with self-addressed envelopes to all the family doctors registered in Malta. The list of the practitioners was obtained from the Malta Medical Council and their contact details were derived from the European Union Practitioner list. 3. Results There was a sixty-one percent response rate. The majority of the family doctors were males, Maltese and solo practitioners who had been practicing between eleven and thirty years and who had never consulted any guidelines in the previous weeks. The other practitioner characteristics were equally distributed. Most of the doctors scaled highly their knowledge on respiratory tract infections and their treatment and agreed with delayed prescribing but were not willing to prescribe new antibiotics.

Family doctors were found to be affected by patient's age and gender, the smoking status, the clinical condition of the patient and by patients who were persistent in their demands. Family doctors were also affected by occupational factors and by certain social factors. The clinical symptoms that prompt the practitioners in prescribing an antibiotic are greenish nasal discharge, cough productive of greenish sputum, shortness of breath and high fever. The doctors are also more ready to prescribe an antibiotic when on examination they find pustular tonsillitis, otitis media or externa, frontal percussion tenderness, localised chest crepitations and enlarged cervical lymph nodes. Antibiotic prescribing is also affected by practitioner characteristics, namely, gender, duration and area of practice, consultation of prescription guidelines, knowledge of respiratory tract infections and their treatment, willingness to prescribe a new antibiotic and agreement with delayed prescribing.

4. Discussion Locally practicing family doctors are affected by patient characteristics that would normally require extra attention in prescribing an antibiotic due to their increased susceptibility to respiratory tract infections or due to possible adverse reactions. They are aware of the importance of considering occupational factors in the management of the patient and also look at the need of the community in their decisions to prescribe an antibiotic. They are sensitive to particular social circumstances though not to economic difficulties. The doctors are also affected by persistent patients but not by direct patient expectations. Particular clinical characteristics indicating a bacterial infection induce practitioners to prescribe an antibiotic but characteristics that falsely picture severity have also an impact on the doctors, thus possibly contributing to inappropriate prescribing. Inappropriate prescribing was related to male practitioners, increasing

duration of practice, rural practice, increasing guidelines consultation, decreasing knowledge of respiratory tract infections and treatment, increasing willingness to prescribe new antibiotics and decreasing approval of delayed prescribing.

5. Conclusion This study shows what affects the family doctors in their prescription patterns, thus indicating which practitioner groups and which patient and clinical characteristics need to be addressed in devising programs to control antibiotic overprescribing and thus reduce antibiotic resistance. Further studies are needed to confirm the presence and illustrate the severity of inappropriate antibiotic prescribing in Malta.