Enablers and barriers to the use of antibiotic guidelines in the assessment and treatment of community-acquired pneumonia-A qualitative study of clinicians' perspectives

Background: Community-acquired pneumonia (CAP) is a common condition and a number of guidelines have been developed for its assessment and treatment. Adherence to guidelines by clinicians varies and particularly the prescribing of antibiotics often remains suboptimal. Objective: The aim of this study was to elucidate potential barriers and enablers to the adherence to antibiotic guidelines by clinicians treating CAP in an Australian hospital. Methods: Semi-structured interviews were conducted with purposively recruited senior prescribers who regularly treat CAP in an Australian hospital. Thematic analysis identified a number of themes and subthemes related to their knowledge, attitudes and behaviours associated with the use of CAP guidelines. Results: Thematic saturation was reached after 10 in-depth interviews. Although similar barriers to the use of guidelines as previously described in the literature were confirmed, a number of novel, potential enablers were drawn from the interviews. Clinicians' acceptance and accessibility of guidelines emerged as enabling factors. Generally positive attitudes towards antimicrobial stewardship services invite leveraging what was described as the relationship-based and hierarchical nature of medical practice to provide personalised feedback and updates to clinicians. Conclusions: Adding a social and personalised approach of antimicrobial stewardship to policy- and systems-based strategies may lead to incremental improvements in guideline adherent practice when assessing and treating CAP.