Antibiotic prescribing practices of medical doctors in a resource-limited setting and the influence of individual perceptions and stewardship support: a survey in three tertiary hospitals in Vietnam
Huong Thi Lan Vu, Thuy Thi Thanh Pham, Yen Hai Duong, Quan Anh Truong, Hong Khanh Nguyen, Tu Thi Cam Nguyen, Long Xuan Trinh, Ha Thi Hong Nguyen, Minh Quang Le, Vinh Hai Vu, Duc Minh Chau, Nguyet Thi Huynh, Em Thi Hoang Dung Vo, Hoa Nguyen Minh Le, Thach Ngoc Pham, Todd M Pollack, H Rogier Van Doorn- Microbiology (medical)
- Infectious Diseases
- Immunology and Allergy
- Microbiology
- Immunology
Abstract
Objectives
To understand antibiotic prescribing and influencing factors to inform antimicrobial stewardship (AMS) interventions to reduce unwanted consequences of antibiotic use in hospitals in Vietnam, a lower-middle-income country in Asia.
Methods
We conducted a cross-sectional study of doctors at three tertiary hospitals using non-probability convenience sampling, through a paper-based (Hospitals 1 and 2) or electronic (Hospital 3) survey. Questions included items on perceptions regarding antibiotic resistance and AMS, prescribing practices, knowledge, demographics and training. We used principal components analysis and mixed-effects models to examine practices and identify influencing factors.
Results
Among 314 surveyed participants, 61%, 57% and 59% in Hospitals 1, 2 and 3, respectively, felt certain about the appropriateness of their antibiotic prescriptions. In total, 9% reported sometimes prescribing antibiotics when not needed to meet patients’ expectations, and 13% reported doing so to avoid perceived complications. Higher prescribing confidence was found among those with positive perceptions about AMS (P < 0.0001), whereas negative perceptions about colleagues’ practices reduced this confidence (P < 0.0001). Individual preference for branded antibiotics was associated with more unnecessary prescribing whereas having higher prescribing confidence decreased the habits of prescribing when not needed.
Conclusions
This study provides important implications for design of hospital interventions to address influencing factors on antibiotic prescribing in Vietnam and similar resource-limited settings. Specific interventions should target improving knowledge through education and training for doctors, enhancing the support from the AMS team, and promoting guidelines and policies for appropriate antibiotic use in hospital.