Determinants of inappropriate antibiotic prescription in primary care in developed countries with general practitioners as gatekeepers: a systematic review and construction of a framework

Key Points

• To identify the determinants of inappropriate antibiotic prescribing in primary care in developed countries with general practitioner gatekeeping models and develop an explanatory framework.
• Conducted a systematic review of literature from developed countries operating general practitioner gatekeeper systems (PROSPERO CRD42023396225).
• Synthesized multi-level factors influencing clinician decision-making to construct a structured analytical framework.
• Categorizes determinants of inappropriate prescribing across clinical, interpersonal, institutional, and policy levels in primary care.
• Provides a structured framework to inform targeted antibiotic stewardship interventions and reduce unnecessary prescriptions in gatekeeper healthcare models.