Motivation for improving antibiotic use in nursing homes: a qualitative study set among health care professionals

Abstract Background The inappropriate use of antibiotics is highly prevalent in nursing homes. This study is aimed at exploring the motivation for improving antibiotic use among different categories of health care professionals in nursing homes to inform the development of effective antibiotic stewardship programs. Methods Individual semistructured interviews were conducted with 9 assistant nurses, 15 nurses, 13 general practitioners, 5 coordinating general practitioners and 3 coordinating nurses from 8 French nursing homes. The transcripts were thematic analyzed using a general inductive approach. Results Health care professionals in nursing homes are motivated to improve the use of antibiotics, but various factors constrain this motivation. Assistant nurses and nurses reported seeing themselves as mere operators, not considering responsible in antibiotics use. General practitioners reported being open to changing practices if such a change benefited their patients, but they felt hindered from changing their practices because of the limited choices available regarding antibiotic treatments. Coordinating general practitioners and coordinating nurses encountered organizational difficulties in improving antibiotic use because of (i) the absence of a hierarchical relationship with general practitioners and (ii) a lack of medical resources, which resulted in over prescription, particularly right before weekends, to avoid the risk of worsening the residents’ conditions or the risk of hospitalization. Conclusions Beyond individual attitudes, motivation is shaped by structural features, particularly that involving the organization of health care in nursing homes, which seems pivotal for improving antibiotic use in such settings. Potential approaches that could be explored to promote antibiotic stewardship in nursing homes include (i) dedicated training for assistant nurses and nurses so that they can accurately alert general practitioners (i.e., give nurses the skills to avoid over alerting) and (ii) formalized conventions between nursing homes, and community general practitioners and/or advanced practice registered nurses to better manage after-hours medical resources. Trial registrations ClinicalTrials.gov: ID NCT07246382.