Why do we prescribe what we prescribe?

In this video, David Tisdall discusses the factors involved in our prescribing decisions.

There are several extrinsic and intrinsic factors that are considered.

Click to enlarge

Often it is these intrinsic factors, alongside the practice culture and client expectations, that can have a biggest influence on prescribing decisions. A tendency towards defensive prescribing is common. This is also the same in human medicine. For example, this study, found that individual GP prescribing behaviour had a greater influence on AM prescription than the clinical picture.

Another study, in a hospital scenario, looked at compliance of physicians with antimicrobial guidelines. It found that patient characteristics had limited effect on compliance. There was a tendency towards defensive prescribing and the use of more broad-spectrum antibiotics, particularly with severe infections, without de-escalation following culture and sensitivity testing. The authors of this study suggested that clinicians may have been prioritising perceived treatment efficiency and efficacy in individual cases, over the bigger picture of reducing AMR risk.

In summary:

Professor Dame Sally Macintyre, University of Glasgow, said

“The mechanisms which lead to antimicrobial resistance are biological. However, the conditions promoting, or mitigating against, these biological mechanisms are profoundly social.”

Antimicrobial stewardship is fundamentally an issue of behavioural change.

For more information on behavioural change and methods of implementing change into practices, take a look at this course: Tackling Antimicrobial Resistance: A Social Science Approach.

In the comments section below, discuss your answers to the question David posed at the start of the video: what questions do you ask yourself before deciding to prescribe an antibiotic?

Do you think you tend to defensively prescribe? When and why are most likely to do so?

How could you change the questions that you ask yourself, so that defensive prescribing is avoided?

In the see also section, an article has been provided for further reading.

Please find a downloadable copy of the PowerPoint slides used in the video in the downloads section below.