Table 1 Study characteristics
Author (year) | Country | Objective | Study design | Study approach | Study population | Sample size | Data collection methods | Setting | Data analysis | Overall Quality Score from 5 criteria |
|---|---|---|---|---|---|---|---|---|---|---|
Palin, et al. [25] | UK | Examine factors and variations across general practices in antibiotic prescribing | Retrospective observational study | Quantitative | Patients and physicians | 587 | Extract from online database | Primary health care | Descriptive and changing point analysis | 5 |
Lum, et al. [6] | Australia | To Identify dominant factors in decision of antibiotic prescription | Observational (exploratory) | Mixed method | General practitioner | 10 | Interview and the discrete choice experiment | Primary health care | Thematic analysis and descriptive | 5 |
van der Velden, et al. [20] | 18 European countries | To identify Factors related to antibiotic prescription and describe between countries difference | Observational (prospective) | Quantitative | Physicians and patients | 4982 patients and 143 physicians | Point-prevalence audit survey | Primary health care | Descriptive and inferential | 5 |
Theodorou, et al. [26] | Greece and Cyprus | To investigate attitudes and the factors that influence physician prescribing decisions and practice | 0bservational (cross-sectional study) | Quantitative | Physicians | 1703 | Survey | Both primary and secondary care | Descriptive and inferential | 4 |
Queder, et al. [18] | Germany | To identify contextual factors associated with practitioners’ perceptions of antibiotic prescribing | Observational (prospective study) | Quantitative | Physicians | 229 | Survey | Primary health care | Descriptive and inferential | 5 |
Chan, et al. [27] | Singapore | To understand the determinants influencing antibiotic prescribing decisions | Observational (cross-sectional study) | Qualitative | Physicians | 19 | In-depth interviews | Both secondary and primary healthcare | Descriptive and thematic analysis | 4 |
Ahmadi and Zarei [28]) | Iran | To explore the prescribing patterns and rational drug use for family physicians | observational (retrospective) | Quantitative | Family physician | 184 | Observation and analysing of prescriptions | Primary health care | Descriptive analysis | 4 |
Kotwani, et al. [29] | India | To explore the factors that influence primary care physicians to prescribe antibiotics and to investigate possible interventions | Observational (cross-sectional) | Qualitative | Physicians | 36 | Focus group discussions | Primary healthcare | Grounded theory | 4 |
Fletcher-Lartey, et al. [30]- | Australia | To describe the role patient expectations, play in general practitioners antibiotic prescribing | Observational (cross-sectional) | Mixed methods | Physicians | 584 | Survey and interviews | Primary care | Descriptive and framework analysis | 5 |
Laka, et al. [31] | Australia | To identify perceived barriers to appropriate antibiotic prescribing across different healthcare settings | Observational (cross-sectional) | Quantitative | Physicians | 180 | Survey | Australian hospitals and primary care | Descriptive and content analysis | 5 |
Swe, et al. [32] | Myanmar | To quantify prescriber variability in antibiotic prescription to patients with acute fever | Observational (retrospective) | Quantitative | Patient and physicians | 1090 patient consultations with 40 doctors | From online database | Primary healthcare clinics | Descriptive and inferential | 4 |
Mousquès, et al. [33] | France | To measure variability of antibiotic prescription by French general practitioners for acute rhinopharyngitis | Observational (retrospective) | Quantitative | Patients and physicians | 778 general practitioners | Collected retrospectively from recorded patient files | Primary care and hospitals | Descriptive and inferential | 4 |
Björnsdóttir, et al. [34] | Iceland | To map physician decision-making for common infections, exploring their diagnostics basics for antibiotic prescriptions | Observational (cross-sectional) | Qualitative | Physicians | 10 | Interviews | Primary health care | Ground theory | 3 |
Bharathiraja, et al. [35] | India | To understand the antibiotic prescription pattern and factors influencing it | Observational (cross-sectional) | Quantitative | Physicians | 40 | Observation and analysing of prescriptions | Primary health care | Descriptive analysis | 3 |
Cadieux, et al. [36] | Australia | To assess whether physician knowledge, time in practice place of training and practice volume explain the difference in antibiotic prescribing among physicians | Observational (retrospective) | Quantitative | Physicians | 852 | Extracted from online database, | Primary care physicians | Descriptive and inferential | 5 |
Skodvin, et al. [37] | Norwegian | To investigate factors influencing doctors’ antimicrobial prescribing practices | Observational (cross-sectional) | Qualitative | Physicians | 15 | Interviews | Primary care and hospital setting | Thematic analysis | 5 |
Guo, et al. [38] | Singapore | To explore processes underpinning decision-making for antibiotic prescribing by considering doctors' experience in different primary care settings | Observational (cross-sectional) | Qualitative | Physicians | 30 | Interviews | Primary healthcare settings | Thematic analysis | 5 |
Borek, et al. [39] | UK | To assess social and contextual factors affecting antibiotic prescribing and engagement with antimicrobial stewardship | Observational (cross-sectional) | Qualitative | Physicians | 41 | Interviews | Primary health care | Thematic analysis | 4 |
Béjean, et al. [40] | French | To identify the different practice profiles of general practitioners in order to test the hypothesis of heterogeneity in physician behaviour | Observational (retrospective) | Quantitative | Physicians | 4,660 | Extract from database | Primary care and hospitals | Cluster analysis and inferential analysis | 5 |
Sydenham, et al. [41] | Denmark | To assess the importance of factors that influence decision by GPS to prescribe antibiotics for acute respiratory tract infections | Observational (cross-sectional) | Quantitative | Physicians | 3336 | Survey including discrete choice experiments | All healthcare settings | Descriptive and inferential | 5 |
Schwartz, et al. [12] | Canada | To describe factors of overall antibiotic prescribing as well as the inter-physician variability in antibiotic prescribing among family physicians | Observational (retrospective) | Quantitative | Family Physicians | 313 | Extract from online database | Not specify | Descriptive and inferential | 3 |
Aabenhus, et al. [8] | Denmark | To identify practice-related factors associated with high prescribers, including prescribers of critically important antibiotics as defined by WHO | Observational (retrospective) | Quantitative | Physicians | 1962 | Extract from online database | From all health care service | Descriptive and inferential | 4 |
Pouwels, et al. [42] | UK | To explore to what extent factors such as patient comorbidities explain this variation in antibiotic prescribing | Observational (retrospective) | Quantitative | Physicians | 348 | Extract from online database | Primary health care | Descriptive and inferential | 5 |
Paluck, et al. [43] | Canada | To investigate whether overprescribing is common in treatment of paediatric upper respiratory infections and to examine factors that influence prescribing antibiotics for antibiotic prescription | Observational (cross-sectional) | Quantitative | General and family physicians | 608 | Postal survey | Primary health care and family clinics | Descriptive analysis | 4 |
Kumar, et al. [44] | UK | To understand why general practitioners, prescribe antibiotics for some cases of sore throat and to explore the factors that influence their prescribing | Observational (cross-sectional) | Qualitative | Physicians | 40 | Interview | Primary health care | Ground theory | 3 |
Simpson, et al. [45] | UK | To understand of general practitioners’ perceptions of antimicrobial resistance | Observational (cross-sectional) | Qualitative | Physicians | 40 | Interview | Primary health care and hospitals | Grounded theory | 4 |
Wood, et al. [46] | UK | Explore the reasons for their choice of prescribed antibiotic, in particular, their decision | Observational (cross-sectional) | Qualitative | Physicians | 40 | Interview | Primary health care | Grounded theory | 4 |
Reynolds and McKee [47] | China | To assess knowledge, attitude and practice about the use of antibiotics and assess factors influencing antibiotic prescribing | Observational | Mixed methods | Patients and physicians | 24 patients and 12 doctors | Survey, interviews and focus group discussion | Primary care and hospitals | Descriptive and grounded theory | 4 |
Bjorkman, et al. [48] | Sweden | To explore and describe perception of antibiotic prescribing among Swedish hospital physicians | Observational (cross-sectional) | Mixed method | Physicians | 25 | Interviews and survey | Primary health care | Narrative analysis and descriptive | 4 |
Björkman, et al. [49] | Sweden | To explore and describe the variation in GPS perception of infectious diseases management with special reference to antibiotic prescribing | Observational (cross-sectional) | Qualitative | Physicians | 20 | Interview | Primary care | Thematic analysis | 5 |
Vazquez-Lago, et al. [50] | Spain | To ascertain the opinions and attitudes of general practitioners in Spain concerning antibiotics prescription and resistance | Observational (cross-sectional) | Qualitative | Physicians | 33 | Focus group discussion | Primary health care | Thematic analysis | 4 |
Akkerman, et al. [51] | Netherlands | To assess determinants of antibiotic overprescribing in patients with sinusitis, tonsillitis and bronchitis in Dutch general practice | Observational (cross-sectional) | Quantitative | Physicians with their patients | 146 | Observation of prescribed papers | Primary health care | Descriptive and inferential | 4 |
Wester, et al. [52] | USA | To know about prescribers' views on antibiotic resistance and impact on prescription | Observational (cross-sectional) | Quantitative | Internal medicine physicians | 490 | Survey | Primary health care and hospitals | Descriptive analysis | 4 |
van der Zande, et al. [53] | UK | To understand contextual factors related to general practitioners' antibiotic prescribing behaviour in low, high, and around the mean prescribing primary | Observational (cross-sectional) | Qualitative | Physicians | 41 | Interviews | Primary health care | Thematic analysis | 5 |
Chem, et al. [54] | Cameroon | To investigate prescribing patterns and predictors of antibiotic prescription in primary healthcare facilities | Observational (retrospective) | Quantitative | Physicians | 30,096 prescriptions and 59 physicians | Observation of prescription and survey | Primary health care | Descriptive and inferential | 4 |
Beilfuss, et al. [55] | USA | To estimate heterogeneous treatment responses across specialties | Randomized-controlled trial | Quantitative | Physician | 645,620 | Extract from recorded data and patient survey scores | Primary health care | Descriptive and inferential analysis | 5 |
Zetts, et al. [56] | USA | To assess physicians' current attitudes towards antibiotic resistance, inappropriate antibiotic prescribing and the feasibility of outpatient stewardship efforts | Observational (cross-sectional) | Qualitative | Physicians | 52 | Focus group discussion | Primary health | Thematic analysis | 5 |
Rodrigues, et al. [57] | Portugal | To compare both the attitudes and knowledge between primary care and hospital care physicians with regards to antibiotic prescribing | Observational (cross-sectional) | Quantitative | Physicians | 56 | Survey | Primary health care and hospital | Descriptive and inferential | 4 |
Alradini, et al. [58] | Saudi Arabia | To identify the sociocultural and behavioural determinants that affect antibiotic prescription behaviour among primary care physicians and estimate the awareness about antibiotic resistance of public health importance | Observational (cross-sectional) | Quantitative | Physicians | 434 | Survey | Primary care | Descriptive and inferential | 4 |
Tang, et al. [59] | China | To evaluate the variations in effect of public reporting in antibiotic prescribing practice among physicians with different performance in primary health care | A randomized-controlled trial | Quantitative | Physicians | 60 | Survey and prescription data | Primary health care | Descriptive and inferential | 4 |
Rodrigues, et al. [60] | Portugal | To assess the influence of the determinants of physicians prescribing on the quality of antibiotic use | Observational (prospective) | Quantitative | Physicians | 1094 | Survey and use antibiotic prescribing quality indicators | Primary-care | Descriptive and inferential | 5 |
Al-Homaidan and Barrimah [61] | Saud Arabia | To evaluates primary health care physicians' knowledge expectation and practice regarding antibiotics use in upper respiratory tract infections | Observational (cross-sectional) | Quantitative | Physician | 294 | Survey | Primary health care | Descriptive and inferential | 4 |
Frost, et al. [62] | USA | To evaluate variation in antibiotic prescribing between paediatric and nonpediatric providers for common upper respiratory illnesses | Observational (retrospective) | Quantitative | Paediatric and physician | 141 361 | Extraction from online database | Primary health care | Descriptive and inferential | 4 |
Karimi, et al. [63] | Iran | To investigate the pattern and factors affecting outpatients’ antibiotic prescribing by family physicians in primary health care | Observational (cross-sectional) | Quantitative | Family physicians | 19 | Evaluation of prescription pattern | Primary health care | Descriptive and inferential | 5 |
Huang, et al. [64] | Singapore | To understand the determinant of antibiotic prescribing for URTI among junior physicians | Observational(cross-sectional) | Quantitative | Junior Physicians | 130 | Survey and interview | Primary health care | Descriptive and principal component analysis | 5 |
Sharaf, et al. [65] | Qatar | Explores barriers to appropriate antibiotic prescription and pharmacists’ perspectives at primary health centres in Qatar | Observational (cross-sectional) | Qualitative | Physicians and pharmacists | 50 | Interview, and focus-groups discussion | Primary health care | The thematic constant comparative method | 3 |
Poss-Doering, et al. [66] | German | To identify factors relevant to primary care physicians’ decision-making when prescribing antibiotics for acute noncomplicated infections | Observational (cross-sectional) | Qualitative | Physician | 27 | Interviews | Primary health care | Descriptive and thematic analysis | 5 |
Liu, et al. [67] | China | To fill the gap, modelling physician antibiotics prescribing and identifying the potential intrinsic and external determinants of antibiotic prescribing in primary care | Observational (cross-sectional) | Quantitative | Physicians | 499 | Survey | Primary health care | Descriptive and two-level path analysis | 5 |
Cordoba, et al. [68] | Bolivia, Paraguay and Uruguay | To describe and compare antibiotic prescribing patterns for primary care patients with respiratory tract infections in South American countries | Observational (prospective) | Quantitative | Physician | 171 | Survey and observation of their prescription | Primary health care | Descriptive and inferential | 4 |