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Mapping the decision pathways of acute infection management in secondary care among UK medical physicians: a qualitative study

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Title: Mapping the decision pathways of acute infection management in secondary care among UK medical physicians: a qualitative study
Authors: Rawson, T
Charani, E
Moore, L
Hernandez, B
Castro Sanchez, E
Herrero Vinas, P
Georgiou, P
Holmes, A
Item Type: Journal Article
Abstract: Background The inappropriate use of antimicrobials drives antimicrobial resistance. We conducted a study to map physician decision making processes for acute infection management in secondary care to identify potential targets for quality improvement interventions. Methods Newly qualified to Consultant level physicians participated in semi-structured interviews. Interviews were audio recorded and transcribed verbatim for analysis using NVIVO11.0 software. Grounded theory methodology was applied. Analytical categories were created using constant comparison approach to the data and participants were recruited to the study until thematic saturation was reached. Results Twenty physicians were interviewed. The decision pathway for the management of acute infections follows a Bayesian-like step-wise approach, with information processed and systematically added to prior assumptions to guide management. The main emerging themes identified as determinants of the decision making of individual physicians were; (i) perceptions of providing “optimal” care for the patient with infection by providing rapid and often intravenous therapy; (ii) perceptions that stopping/de-escalating therapy was a senior doctor decision with junior trainees not expected to contribute; (iii) expectation of interactions with local guidelines and microbiology service advice. Feedback on review of junior doctor prescribing decisions was often lacking, causing frustration and confusion on appropriate practice within this cohort. Conclusion Interventions to improve infection management must incorporate mechanisms to promote distribution of responsibility for decisions made. The disparity between expectations of prescribers to start but not review/stop therapy requires addressing urgently with mechanisms to improve communication and feedback to junior prescribers to facilitate their continued development as prudent antimicrobial prescribers.
Issue Date: 12-Dec-2016
Date of Acceptance: 17-Nov-2016
URI: http://hdl.handle.net/10044/1/42693
DOI: https://dx.doi.org/10.1186/s12916-016-0751-y
ISSN: 1741-7015
Publisher: BioMed Central
Journal / Book Title: BMC Medicine
Volume: 14
Copyright Statement: © The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Sponsor/Funder: National Institute for Health Research
National Institute for Health Research
Funder's Grant Number: II-LA-0214-20008
II-LA-0214-20008
Keywords: Antibiotics
Antimicrobial stewardship
Grounded-theory
Prescriber
Sepsis
General & Internal Medicine
11 Medical And Health Sciences
Publication Status: Published
Article Number: 208
Appears in Collections:Faculty of Engineering
Electrical and Electronic Engineering
Department of Medicine
Faculty of Medicine



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