Survey of US. Doctors Reveals Challenges, Strategies for Reducing Inappropriate Antibiotic Use

To combat antibiotic resistance threats it’s essential to improve how antibiotics are prescribed

Guest Author: By David Hyun and Rachel Zetts
David Hyun, M.D., is a senior officer and Rachel Zetts, M.P.H., is an officer with The Pew Charitable Trusts’ antibiotic resistance project.

The ongoing COVID-19 pandemic has provided a stark reminder of the numerous consequences when a public health crisis hits and there are limited or no effective treatments available. It has also underscored the invaluable role of antibiotics.

Antibiotics are foundational to much of modern medicine—critical for patients fighting cancer, receiving dialysis, undergoing surgery, and requiring countless other medical treatments and procedures. They are also needed to treat secondary bacterial infections that can sometimes occur in hospitalized patients with COVID-19.

That’s why it continues to be critically important to slow the spread of resistance and preserve the effectiveness of existing antibiotics through careful stewardship, which means ensuring these drugs are used appropriately and only when necessary. Unfortunately, doctors sometimes are unaware that their own antibiotic prescribing can be a problem.

According to a national survey from The Pew Charitable Trusts and the American Medical Association, most U.S. primary care physicians see antibiotic resistance as an abstract issue—not something they personally contribute to. Although respondents almost universally agreed that antibiotic resistance (94%) and inappropriate antibiotic prescribing (91%) are nationwide problems in the United States, and a majority (65%) reported a rise in resistant infections among their patients over the past five years, far fewer (37%) viewed inappropriate prescribing as an issue in their own practices. In fact, about 60% believed that they prescribed antibiotics more appropriately than their peers.

Additionally, although almost 72% of doctors agree that stewardship programs are necessary to reduce antibiotic resistance, almost half (46%) of respondents indicated that they would need “a lot of help” to implement stewardship interventions in their own practices.

Despite these barriers, the survey also revealed several specific strategies that doctors say could help spur them to implement stewardship efforts in their practices.

Public Health Is Key to Expanding and Improving Antibiotic Stewardship in Doctor’s Offices 

All public health stakeholders have a role to play in improving antibiotic use, and some of these actions could help doctors implement their own stewardship efforts. Our survey shows that state health departments, payers, and health systems are particularly well positioned to help drive progress.

1. State health departments. More than 80% of physicians surveyed indicated that receiving data on antibiotic resistance patterns in their geographic area would likely encourage them to implement stewardship efforts. Additionally, the majority of respondents ranked state health departments as either the first- or second-most trusted source for providing accurate feedback on their antibiotic prescribing practices. And 79% of doctors said it would be useful if local and state health departments provided technical assistance or other resources to help with antibiotic stewardship activities. Because doctors trust these organizations, state and local health departments can also play a key role in partnering with other health care stakeholders—such as public and private payers—to help build physician buy-in for stewardship activities such as feedback on antibiotic prescribing.
2. Public and private payers. At least three-quarters of doctors agreed that if health insurers integrated antibiotic stewardship into existing quality incentive programs or created new, stand-alone programs to drive stewardship, it would encourage them to implement stewardship efforts in their own practices. Additionally, nearly half of physicians surveyed (44%) felt that health plans, which have access to prescribing data, were in a good position to provide doctors with prescribing feedback.
3. Health care systems. The majority of doctors indicated that their own practice, or health system, was the most trusted source for providing feedback on antibiotic prescribing. Health systems are well positioned to leverage centralized resources and data to support stewardship at individual practices within their network. Intermountain Healthcare’s system-wide, ongoing stewardship program offers a useful model for how health systems can expand stewardship into outpatient facilities.

There is still much to learn about the use of antibiotics for patients with COVID-19. But we do know that the more these drugs are prescribed and new ones are not developed, the more difficult it becomes to combat antibiotic resistance. This is why improving antibiotic prescribing through expanded stewardship is critical. Policymakers, insurers, state health departments, health systems, and other public health stakeholders should use the survey’s complete findings to identify and implement effective strategies. This will help ensure antibiotics are used appropriately, help protect their efficacy, and save patients’ lives.

David Hyun, M.D., is a senior officer and Rachel Zetts, M.P.H., is an officer with The Pew Charitable Trusts’ antibiotic resistance project, which supports efforts to spur the discovery of new antibiotics and ensure that these drugs are prescribed appropriately. Their work focuses on research, and developing strategies and policies that will help improve stewardship of antibiotics in hospitals, doctors’ offices, and other health care settings.

More on this topic:

What Are Doctors Saying About Antibiotic Resistance?

The Invaluable Role of Antibiotics—in a Pandemic and Beyond

Gonorrhea Could Soon Become Untreatable

Five Facts About Antibiotic Resistance