Opposing expectations and suboptimal use of a local antibiotic hospital guideline: a qualitative study

OBJECTIVES: The aim of this study was to determine the opinions and problems concerning the use of a local antibiotic hospital guideline in a 1900-bed tertiary-care, university teaching hospital.

METHODS: A qualitative study using focus group discussions explored the usability and applicability of local antibiotic guidelines together with possible supportive measures. The sample included 22 physicians, deliberately divided between internal medicine (59.1%) and surgery (40.9%), and levels of experience (59.1% residents; 40.9% supervisors). Focus groups were conducted within one specific subgroup. Analysis was carried out using a framework analysis approach.

RESULTS: General acceptance of local guidelines was high but clear differences were present between subgroups with different desires and requirements from guideline contents. Opposing views were present towards supportive measures, especially multidisciplinary collaboration. Guideline distribution and accessibility appeared to be confusing, resulting in delayed application. An important supplementary barrier was the need to collect the guideline personally. Supervisors in their role as opinion leaders were mentioned as highly influential towards residents' practice.

CONCLUSIONS: Locally developed hospital guidelines experience the same barriers as other guidelines. Within one hospital, prescribers have to be seen as a number of different target groups instead of a homogeneous population. For an optimal effect, interventions will have to consider these differences. Also, in order to improve local guideline use and antibiotic consumption, supervisors have to be aware of how their role as opinion leaders can influence residents. Lastly, active guideline distribution and promotion remains critical to ensure efficient guideline use. Future research should focus on how to adapt interventions to these different target groups.