General practitioners’ perspectives on barriers and facilitators of the implementation of the ANTIBIORESIST antibiotic stewardship audit and feedback intervention: a qualitative interview study among high prescribers

Abstract

Abstract Background Audit and feedback (A&F) interventions are critical for improving antibiotic prescribing practices among general practitioners (GPs) but more knowledge about the optimal ways to deliver them is needed. The French ANTIBIORESIST programme delivers individualized A&F based on proxy indicators estimating the appropriateness of antibiotic prescriptions. Objectives This study aimed at exploring high prescribing GPs’ perspectives on barriers to and facilitators of implementation (i.e. acceptability, demand and integration into daily practice) of the ANTIBIORESIST A&F intervention. Methods Semi-structured interviews were conducted (May–October 2024) with 10 GPs from northeastern France whose prescribing patterns were the least compliant with guidelines and who had received ANTIBIORESIST A&F intervention. The data were analysed thematically based on the Bowen’s feasibility framework. Results Twenty-two elements were identified across A&F design, cognitive accessibility, reaction to performance score, perceived legitimacy of the provider and delivery modality. Facilitators included concise, colour-coded feedback, relevance of proxy indicators and in-person delivery. Barriers included misunderstanding and misinterpretation of proxy indicators, the perception that they are not applicable to their own context of practice and scepticism towards the feedback provider. Heterogeneity in interpretation of proxy indicators often hinders acceptability. Integration would be enhanced if feedback were delivered via digital workspaces, yet GPs expressed concerns about coercion and A&F futility. Conclusions Addressing cognitive and contextual barriers is essential for optimizing A&F interventions. Enhancing the clarity, legitimacy of the feedback provider and delivery methods, coupled with supportive co-interventions, may strengthen the impact on antibiotic prescribing in primary care.