Factors influencing primary care physicians to prescribe antibiotics in Delhi India

Objective. To explore the factors that influence primary care physicians to prescribe antibiotics and to investigate possible interventions. Methods. Focus group discussions (FGDs) were used to explore the perspectives of primary care physicians in the public and private sectors from five municipal wards (residential localities) of Delhi from where data on antibiotic use and resistance were collected. FGDs (n = 3 with 36 prescribers) were analysed through grounded theory. Results. Three broad themes identified were as follows: behavioural characteristics of doctors and patients; laxity in regulation of prescribing and dispensing antibiotics and intervention strategies to decrease misuse of, and resistance to, antibiotics. Important factors identified for antibiotic prescriptions by doctors were diagnostic uncertainty, perceived demand and expectation from the patients, practice sustainability and financial considerations, influence from medical representatives and inadequate knowledge. For public sector doctors, besides the above, overstocked and near-expiry drugs and lack of time were the factors that promoted antibiotic overuse. Doctors also identified certain patient behaviour characteristics and laxity in regulation for prescribing and dispensing of antibiotics as aggravating the problem of antibiotic misuse. Interventions like Continuing Medical Educations for doctors, awareness raising of patients, shared decision making and stricter rules and regulations were suggested to promote rational use of antibiotics in the community. Conclusion. Exploration of doctors' antibiotic use practices and possible interventions will be helpful in carrying out interventions to promote appropriate use of antibiotics in the community.