A needs assessment study for optimising prescribing practice in secondary care junior doctors: the Antibiotic Prescribing Education among Doctors (APED)

Abstract

Background: Appropriate antimicrobial prescribing is essential for patient care, yet up to half of antimicrobial prescriptions written in the UK are sub-optimal. Improving prescriber education has recently been promoted as a mechanism to optimise antimicrobial use, but identification of key learning objectives to facilitate this is so far lacking. Using qualitative methods we investigated junior doctor knowledge, attitudes, and behaviours around antimicrobial prescribing to identify key areas to address in future educational programmes.

Methods: A cross-sectional survey of qualified doctors in training in West London was undertaken exploring antimicrobial prescribing practices and educational needs.

Results: Among 140 junior doctors from 5 London hospitals, a third (34 %) reported prescribing primarily unsupervised, and two thirds (67 %) reported difficulties obtaining prescribing support outside of hours. 20 % stated not feeling confident in writing an antimicrobial prescription, but confidence was increased through having confirmatory diagnostic results (24) and obtaining advice from a senior doctor (26 %); whether this senior was from their own specialty, or an infection-specialist, varied significantly (p < 0.01) by experience. Only a small percentage (5-13 %; depending on number of years post-qualification) of participants stated their previous antimicrobial education was effective. 60 % of those in their first year post qualification reported wanting further education in antimicrobial prescribing, rising to 74 % among more experienced junior doctors. Specific areas of educational need identified were (i) principles of antimicrobial prescribing, (ii) diagnosis of infections, (iii) clinical review of patients with infections, (iv) prescribing in the context of antimicrobial resistance, and (v) laboratory testing and test results.

Conclusions: A significant proportion of junior doctors report lone prescribing of antimicrobials in the context of low self-perceived confidence and knowledge in this field, and frequent difficulty in accessing help when necessary. Innovative training, targeting five specific areas identified through this needs assessment, is urgently needed by junior doctors practising in secondary care.

Keywords: Antimicrobials; Behaviour; Clinical education; Continuing medical education; Knowledge.

Fig. 1

Factors influencing junior doctor confidence around antimicrobial prescribing (n = 140). Legend: This figure represents each of the 4 factors reported as influencing antimicrobial prescribing confidence by junior doctors. These factors form individual axes which have been arranged radially around a point. The value of each aspect is depicted by the node (anchor) on the spoke (axis). A line is drawn connecting the data values for each spoke. Percentages represent the proportions of respondents stating the variable influencing their confidence

Fig. 2

Characteristics of additional antimicrobial prescribing training that junior doctors would like to receive (n = 140). Legend: Proportion of respondents indicating a preference for type of education delivery (green), format of education (red) and content of educational activity (blue)