‘Everyone plays defence’: a qualitative exploration of issues that influence the prescribing of antibiotics by Portuguese dentists

Objective: The aim of this study was to explore issues influencing antibiotic prescribing by Portuguese dentists. Methods: Semi-structured qualitative interviews were conducted with 14 purposively selected dentists. Interviews were audio-recorded with consent, anonymised during verbatim transcription and analysed using the five-stage ‘Framework Approach’, with the aid of the software WebQDA. Ethical approval was granted. Results: ‘Defensive’ practice emerged as a significant influence on antibiotic prescribing by Portuguese dentists, based on concerns related to avoiding clinical complications and fears of losing patients. Analysis indicated a divide regarding the influence of guidelines on antibiotic prescribing; their influence seemed subtle, even among those who claimed to use them for decision-making. The influence of peers appeared minimal, although less experienced dentists considered it an issue. Dentists recognised the existence of patient pressure; patient demand for antibiotics was mentioned, as well as expectations of not being prescribed such drugs. Pressure from pharmaceutical sales representatives was not unanimously acknowledged; even those mentioning it attempted to demonstrate reluctance in changing prescribing habits. Clinical experience recurred in the dataset as an overarching influence on antibiotic prescribing. Conclusions: The main factors that influence antibiotic prescribing appear to be issues intrinsic to dentists, such as a defensive practice and clinical experience; issues related to the environment seem less prominent. Multimodal interventions targeting both knowledge gaps and these intrinsic issues, such as audit and feedback combined with behaviour change messages, may be useful in optimising antibiotic prescribing in Portuguese dentistry.