1887. Primary Care Physicians’ Attitudes and Perceptions Toward Antibiotic Resistance and Outpatient Antibiotic Stewardship: A Qualitative Study

BACKGROUND: The majority of antibiotics in the United States are prescribed in outpatient settings and at least 30% of these antibiotics are unnecessary. Outpatient antibiotic stewardship is needed to minimize the threat of antibiotic resistance (AR). We assessed primary care physicians’ (PCPs) attitudes and perceptions of AR, inappropriate antibiotic use, and outpatient antibiotic stewardship activities. METHODS: We conducted eight focus groups with outpatient PCPs in four US cities: Philadelphia, PA; Birmingham, AL; Chicago, IL; and Los Angeles, CA. Two focus groups were conducted in each city—one with family medicine and internal medicine physicians and one with pediatricians. All focus groups were audio-recorded, transcribed, and coded for major themes in NVivo 11. RESULTS: A total of 26 family medicine/internal medicine physicians and 26 pediatricians participated. Most participants acknowledged that AR is an important public health issue but many considered it to be more of an issue in hospitals and less important in their daily practice when compared with other issues, such as obesity, diabetes, and opioids. PCPs agreed that inappropriate antibiotic use is a problem in outpatient medicine but placed responsibilities on nonprimary care settings such as urgent care and retail clinics, and on patient demand. When discussing possible stewardship activities, participants expressed concerns about measuring inappropriate antibiotic use, questioning the feasibility of assessing prescribing quality while accounting for different patient populations. Participants also argued that other physicians will “game the system” to improve scores. Their perceptions of stewardship were also influenced by their dissatisfaction with quality measurement systems in general and distrust in the accuracy of its tracking and reporting processes. In contrast, participants reacted positively to education efforts for patients and clinicians. CONCLUSION: PCPs recognize the public health importance of AR and inappropriate antibiotic use, but are skeptical about its relative importance and the feasibility and effectiveness of stewardship activities. Addressing these perceptions and skepticism will be integral to the development of outpatient stewardship strategies. DISCLOSURES: J. Doctor, The Pew Charitable Trusts: External advisor, Honorarium for time dedicated to research project. Precision Health Economics: Consultant, Consulting fee. University of Pennsylvania Health System: Consultant, Consulting fee. J. S. Gerber, The Pew Charitable Trusts: External advisor, Honorarium for time dedicated to research project. J. A. Linder, The Pew Charitable Trusts: External advisor, Honorarium for time dedicated to research project.