Antibiotic prescribing: a qualitative evidence synthesis of non-medical prescribers' decision making
Rachel Orr, Jamie Smith, Špela Oberstar, Hazel McPhillips, Gosha ColquhounBackground:
Antimicrobial resistance is a major global health challenge, driven by inappropriate antibiotic use. In the UK, non-medical prescribers (NMPs) play a key role in prescribing across various settings. Understanding NMPs' prescribing decisions in real-world contexts is essential for effective antimicrobial stewardship.
Aim:
This review aimed to synthesise qualitative research exploring the factors influencing NMPs' antibiotic prescribing decision-making.
Methods:
A systematic review following PRISMA guidelines searched six databases. Quality was appraised using CASP and MMAT tools. Thematic synthesis was used to inductively identify and refine themes.
Findings:
Ten studies (2012–2024) involving 140 NMPs identified four themes: diagnostic uncertainty and clinical decision-making; patient expectations and communication dynamics; professional identity; and organisational pressures. Prescribing decisions emerged from interactions between clinical ambiguity, relational negotiation, and structural constraints.
Conclusion:
Effective antimicrobial stewardship requires integrated strategies combining communication training, experiential learning, supportive supervision, improved diagnostics and interprofessional collaboration, alongside policy embedding NMPs in stewardship governance.