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

Antibiotic stewardship—ensuring that these drugs are used only when necessary and prescribed appropriately—is proven to slow the emergence of resistance and improve patient outcomes. Given that inappropriate antibiotic prescribing continues to be prevalent in the U.S., and with early indications of high levels of antibiotic use among COVID-19 patients, stewardship efforts have never been more important. But what happens when doctors don’t see a problem with their prescribing?

According to a new national survey from The Pew Charitable Trusts and the American Medical Association, U.S. primary care physicians generally agree that antibiotic resistance and inappropriate antibiotic prescribing are a threat, but most do not think these are problems in their own practice. Additionally, although the majority of doctors (almost 72%) agree that stewardship programs are necessary to reduce antibiotic resistance, almost half of respondents (about 47%) feel they would need “a lot of help” to implement stewardship interventions in their own practice.

Despite these barriers, there are several specific strategies that doctors say could help spur them to implement stewardship efforts in their practice.

Stakeholders 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 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 spur them to implement stewardship efforts. This was the strongest performing option of all the potential activities presented. 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 spur them to implement stewardship efforts within their own practices. Additionally, nearly half (about 44%) of physicians surveyed 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 efforts at the individual practices within their network. Intermountain Healthcare’s ongoing stewardship program offers a useful model on how health systems can expand stewardship into outpatient facilities.

Much work remains to combat antibiotic-resistant bacteria, and improving antibiotic prescribing through expanded stewardship efforts is critical. Policymakers, insurers, state health departments, health systems, and other public health stakeholders should take a close look at the survey’s complete findings and use them to identify and implement effective strategies to ensure that antibiotics are used appropriately. Doing so will help protect the efficacy of antibiotics and save 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.