A survey of perceptions, attitudes and practices regarding the antibiotic prescription among Iranian physicians

ABSTRACT

Background: Over-prescription and overuse of antibiotics are a major cause of concern in terms of healthcare and economic implications, as well as the emergence of microbial resistance worldwide. So far, efforts have been administered by many countries to regulate the consumption of antibiotics and overcome the rapid emergence of resistant bacteria. Assessment of the perspectives and behavior of physicians can play a major role in achieving this objective.

Objectives: The objective of the present study was to assess the perspectives on the antibiotic prescription practice of physicians and evaluate their tendency to receive feedback on their performance in outpatient settings.

Materials and methods: Attitudes and practices of 330 physicians on antibiotics prescription were evaluated using a validated questionnaire in 2014 in Mashhad, Iran.

Results: 94% of physicians asserted that the prescription rate of antibiotics in Iran is higher than the global average. Physicians noted that “patients’ tendency to prescribe antibiotics“ is the primary reason of excessive prescription of antibiotics. Approximately, 84% of physicians were keen on receiving performance feedback. More than 71% of participants specified Short Message Service (SMS) notification as their preferred medium for receiving feedback.

Conclusions: The dominant viewpoint of physicians was that the rate of antibiotics prescription in Iran is larger than the global average, which can lead to adverse economic and bacterial resistance consequences. Interventions such as ‘performance feedback’ have the potential to reduce antibiotics over-prescription.

KEYWORDS:

• Antibiotics
• electronic feedback
• outpatients
• physicians
• Short Message Service (SMS)

Article highlights

• The majority of the respondents (94%) stated that the rate of antibiotics prescription in Iran is higher than the global average.

• The ‘patients demands’ or ‘patient persistence’ and ‘lake of receiving performance feedback’ by physicians are the main reasons for poor antibiotics prescription standards.

• Receiving performance feedback by SMS, electronic mail, and internet portal were preferred over other technology-based tools.

• ‘Persian reference books’, ‘continuing medical education (CME) programs’ and ‘The web’ are identified as physicians’ preferred tools for improving their medical knowledge.

• More than 75% of physicians believed that their awareness of microbial resistance to antibiotics can help them choose appropriate antibiotics.

Acknowledgments

This study was part of the first author’s Ph.D. thesis which was supported by a grant from Mashhad University of Medical Sciences Research Council (Number: 921638, Date: 9 July 2014). We would like to acknowledge Dr. Mostafa Mostafavi & Sepideh Hasibian for English editting and the Continuing Medical Education (CME) center of Mashhad University of Medical Sciences.

Author contributions

S Eslami, M Saberi, and H Vakili Arki conceived the study idea and design. S Eslami, E Nabovati, and H Vakili Arki participated in the questionnaire design and adaptation. M Farrokhi and H Vakili Arki distributed and gathered the questionnaires. S Eslami, M Farrokhi, and H Vakili Arki interpreted the data. S Aalaei and H Vakili Arki drafted the manuscript. All authors have been involved in critically revising the manuscript. All authors read and approved the final manuscript.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was funded by Mashhad University of Medical Sciences Research Council.