Identifying Barriers and Facilitators for De-implementation of Antibiotics in Acute Uncomplicated Diverticulitis: A Qualitative Study

Background: Diverticulitis is a common gastroenterological condition with significant symptomatic burden for affected patients. Historically, patients with uncomplicated diverticulitis were treated with antibiotics. Recent data suggests antibiotics may be unnecessary for patients with acute uncomplicated diverticulitis, shifting US clinical guidelines towards an antibiotic-sparing approach. Despite this evidence, there remains a lack of adoption of these guidelines. Purpose: This qualitative study aims to identify barriers and facilitators regarding the de-implementation of antibiotics in management of acute uncomplicated diverticulitis. Methods: Semi-structured interviews were conducted with both emergency medicine and primary care providers from October to November 2024. Providers were recruited through email with snowball sampling. Prior to interviews, demographic data was collected through a REDCap survey. Interviews focused on personal experience treating patients with acute uncomplicated diverticulitis and perceived barriers and facilitators for de-implementation of antibiotics. Thematic saturation was reached within the sample size. Interviews were transcribed and qualitatively analyzed using an iterative inductive/deductive approach. Results: Twenty-six providers were interviewed: 12 from primary care and 14 from emergency medicine. Transcripts from interviews were qualitatively analyzed to create an integrative model of barriers and facilitators. Prevalent barriers integrated into the model included systemic factors such as lack of proper follow-up, social influences such as patient expectation of antibiotics, and provider factors such as unawareness of guidelines and studies. Prevalent facilitators included antibiotic stewardship and clinical pathways to guide treatment decisions. Conclusion: This qualitative study identified actionable barriers and facilitators from the perspective of providers regarding de-implementation of antibiotics for acute uncomplicated diverticulitis. Next steps include the development of de-implementation efforts addressing these results, including educational sessions for providers, public health initiatives for patients, enhanced clinical pathways to inform treatment decisions, and antibiotic stewardship feedback on prescription patterns.