2022. Antibiotic Prescribing Behavior Among Surgeon

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Abstract Background A comparative study was conducted to evaluate prescribed antibiotic (AB) use in surgical patients with the Transtheoretical Model of Behavior (TTM) and Theory of Planned Behavior (TPB). Methods A survey was conducted at Thammasat University Hospital from January 1 to 31, 2019. We evaluated the appropriateness of AB uses in the surgical department reported per the hospital’s Drug Use Evaluation (DUE) form. After review of the DUE, in-depth interviews were conducted to all prescribers to explore antibiotic prescribing behavior based on TTM vs. TPB, using a standardized data collection tool. Data collected included demographics, indications, appropriateness of AB uses, the individual prescriber’s behavior based on TTM and TPB. The five TTM stages of change were categorized precontemplation, contemplation, preparation, action, and maintenance. In TPB assessment, we evaluated attitude toward AB uses, subjective norm to AB uses behavior, and perceived behavior control of AB uses behavior. Results There were 92 AB uses from 64 prescribers; 70 (70/92; 76%) used antibiotics appropriately. The majority of AB uses (62/92; 67%) were for treatment of infections. The most common reasons for inappropriate AB uses included inappropriate AB choices for treatment and prophylaxis of SSIs (n = 11, 50%) and inappropriate duration (n = 8, 36%). Physicians categorized in higher stages of TTM (action and maintenance) were strongly correlated with appropriate AB uses, while there was no correlation between the total TPB score and appropriateness of AB uses. By multivariate analysis, the TTM action and maintenance (aOR = 7.95; P = 0.02) and self-reported prescribers who considered patients as first priority (aOR = 4.02; P = 0.04) were associated with appropriate AB uses, while neurosurgical procedures (aOR = 0.13; P = 0.003) and antibiotic prescriptions for surgical prophylaxis (aOR = 0.15; P = 0.04) were associated with inappropriate AB uses. Conclusion Antibiotic prescribers categorized by TTM stages strongly correlated with appropriate AB uses. Additional studies to assess appropriate AB prescribing behavior, based on TTM stages of change, offer an opportunity to optimize surgical care. Disclosures All authors: No reported disclosures.

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