Factors influencing physicians to prescribe antibiotics in Rwanda: a qualitative study

Objectives Antimicrobial resistance continues to downregulate the effectiveness of commonly used antibiotics. Inappropriate antibiotic prescriptions from physicians working in healthcare settings contribute to the excessive use of antibiotics in the community. This study explored the factors influencing physicians to prescribe antibiotics. Methods A descriptive qualitative study was conducted and recruited physicians working in Rwanda’s secondary-level health facilities. A semistructured interview guide was used to conduct in-depth interviews, and thematic analysis was used for data analysis. After listening to the interviews repeatedly, they were transcribed, and the researchers represented the ideas as codes, which were grouped into subthemes and themes according to their similarities. Key findings A total of 24 physicians were recruited from two hospitals: Nyamata Level Two Teaching Hospital, located in a rural area, and Nyarugenge District Hospital, located in an urban area. Three themes were identified to represent factors influencing physicians to prescribe antibiotics. The first theme is “clinical information of patients,” which represents three subthemes: signs and symptoms, laboratory evidence, and risk of infection. The second theme is “need for changing practices,” representing two subthemes: avoiding risks of resistance and the working environment. The third theme is “influence of the patients,” which represents three subthemes: pressure to get antibiotics, the ability of physicians to persuade patients, and trust in patient cooperation. Conclusions We found that physicians working in Rwanda’s secondary-level health facilities experience challenges that can lead to inappropriate antibiotic prescriptions. Rational antibiotic prescription can be promoted by building the capacity to diagnose bacterial infections and training physicians on best prescription practices.