JMIR Publications

ABSTRACT

Background:

Antibiotic resistance (AMR), fueled by irrational prescribing, is a global threat associated with health, social, and economic consequences. Understanding how physicians prescribe antibiotics is important to promote good prescribing practice. This study is aimed at determining factors determining the antibiotic prescribing behaviors of physicians based on the theory of planned behavior in hospitals, in Northwest Ethiopia in 2022.

Objective:

To determine factors influencing the antibiotic prescribing behaviors of physicians based on the theory of planned behavior in hospitals in Northwest Ethiopia in 2022.

Methods:

A cross-sectional study was conducted from September 1, 2022, to October 30, 2022. A total of 185 health professionals were included, and a self-administered questionnaire was used to collect data. A structural equation model based on the theory of planned behavior was adopted to determine antibiotic prescribing behavior based on knowledge, attitudes, subjective norms, perceived behavioral control, and intentions to reduce and prescribe antibiotics. Perceived prescriptions to URTIs and for weekly visits were used to determine physician antibiotic prescribing practices and finally linked with behavioral constructs.

Results:

Physicians estimated to prescribe antibiotics for 54.8% (average, 60.1±53.5) of outpatient encounters in a week, and among 10 patients presented with symptoms of URTIs, 178 (96.2%) (average 5.9±2.2) would be prescribed at least one antibiotic. About 121 (65.4%) of the physicians had good knowledge about antibiotic prescribing. The age of the patient (P = 0.004) and level of profession (p = 0.023) were predictors of perceived prescription to URTI, whereas age of the patient (P = 0.001), sex (P = 0.031), and level of profession (p = 0.018) were predictors of perceived prescription to weekly OPD visits. Knowledge was a direct predictor of the subjective norm (P = 0.000) and perceived behavioral control (P= 0.000) of physicians. However, intentions to reduce use and prescribe antibiotics were not affected by attitude, subjective norm, and perceived control of behavior to prescribe antibiotics (P > 0.05). Similarly, perceived antibiotic prescribing behavior was not affected by intentions to reduce use and prescribe antibiotics (P > 0.05).

Conclusions:

Antibiotic prescribing in hospitals was not under the volitional control of physicians. Since curbing antibiotic overprescriptions will not be improved by knowledge alone, a systematic approach is needed to change antibiotic prescribing practice