Antibiotic use in nursing homes: A qualitative study on knowledge and attitudes among assistant nurses', nurses' and general practitioners'.

BACKGROUND Although antimicrobial stewardship programs have proven effective in hospitals, their implementation in nursing homes remains challenging. To inform the development of antimicrobial stewardship programs, we aim to provide an overview of assistant nurses', nurses' and general practitioners' knowledge and attitudes toward the use of antibiotics.

METHODS Thirty-seven semistructured individual interviews were conducted (9 assistant nurses, 15 nurses and 13 general practitioners). Three separate interview guides - one per health professional - were developed. We performed a thematic analysis following a general inductive approach. All transcripts were double-coded until reaching a kappa of at least 0.80. Data analysis was conducted via NVivo v11.

RESULTS Health professionals' attitudes toward antibiotic use seemed ambivalent. Despite the occurrence of side effects, assistant nurses and nurses indicated that dependent elderly people needed antibiotic prescribing. General practitioners perceived antibiotic use as necessary to prevent rapid deterioration of residents, although they sometimes felt that they could refrain from prescribing. Regarding training needs, assistant nurses and nurses would like to better understand the reasons for antibiotic prescribing.

CONCLUSIONS The development of antimicrobial stewardship interventions could build on the cognitive dissonance unraveled and on expressed need for training by (i) integrating messages about the risks of overprescribing, thus allowing general practitioners to adjust their prescribing and attitudes, and (ii) promoting interprofessional decision-making, for both initial prescription and review, making the best use of nurses' and assistant nurses' knowledge of residents' condition.