The link between physician stress and inappropriate antibiotic prescribing

Handing out antibiotics for illnesses they weren’t meant for is adding to the distress doctors feel

The majority of antibiotic prescriptions are written for things like bronchitis, sore throats, common colds, and the flu, even though they are inappropriate for them. This is not only create a public health concern, but a new study shows that it also contributes to physician distress.

The study, Clinician Distress and Inappropriate Antibiotic Prescribing for Acute Respiratory Tract Infections: A retrospective cohort study, appeared in the May 2022 issue of The Joint Commission Journal on Quality and Patient Safety, and looked at the association between clinician distress and the inappropriate prescribing in adult outpatients.

The researchers examined health records and included outpatient visits in family medicine, general internal medicine, and emergency department visits where an acute respiratory tract infection for an otherwise healthy adult was listed as the primary diagnosis. The depression, anxiety, and burnout levels for the physicians were assessed using the National Institute of Health Patient Report Outcomes Measurement Information System and the Stanford Professional Fulfillment Index Burnout Composite scale obtained from clinician wellness survey data.

Overall, approximately 34% and 50% of clinicians in the study reported depression/anxiety and burnout symptoms, respectively. Findings showed each one standard deviation increase in a clinician’s composite depression and anxiety score was associated with a 28% increase in the odds of an inappropriate antibiotic prescription for an acute RTI. Clinician burnout had no significant association with inappropriate antibiotic prescribing.

“Although the current study was conducted in the pre-COVID-19 era, it is plausible that had this work been repeated during the height of the pandemic, the unique stressor imposed by the COVID-19 pandemic would have shown an even greater prevalence of depression and/or anxiety among clinicians,” Sara C. Keller, MD, MSHP and Pranita D. Tamma, MD, MHS, said in a statement. “We applaud … shedding light on an important and unrecognized area in need of intervention—the impact of provider mental health on inappropriate antibiotic prescribing.”

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