Background Antibiotic prescription rates in primary care in Germany are moderate, but still considered too high. The ARena study (Sustainable reduction of antibiotic-induced antimicrobial resistance) was initiated to foster awareness and understanding of the growing challenge and promotes rational antibiotics use for acute, non-complicated and self-limiting infections. Methods The present study was performed as part of the process evaluation of the ARena study. Interviews were conducted with a purposive sample of physicians participating in the ARena study to identify factors relevant to primary care physicians' decision-making when prescribing antibiotics for acute non-complicated infections. Generated data were audio-recorded. Pseudonymized verbatim transcripts were coded using a pre-defined framework. The Dual Process Theory was applied to provide understanding of individual health professional factors that induce dysrational prescribing decisions. Results Based on medical as well as non-medical considerations, physicians developed habits in decision making on antibiotics prescribing. They acknowledged inadequate antibiotics prescribing for acute, non-complicated infections in situations involving uncertainty regarding diagnosis, prognosis, continuity of care, patient expectations and when not knowing the patient. Educative efforts empowered physicians to override habitual prescribing. A theory-driven model provides transparency as to how dysrational prescribing decisions occur and suggests remedy by providing new experiences and new recognizable patterns through educative efforts. Conclusions Educational interventions may only change prescribing behaviours if they result in active rational rather than routine-based decision-making on antibiotics prescribing. Trial registration ISRCTN, ISRCTN58150046.

中文翻译：

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德国初级医疗保健中抗生素处方决策不合理的复杂现象：使用双过程理论的定性访谈研究。


背景 德国初级保健中的抗生素处方率适中，但仍然被认为过高。 Arena 研究（可持续减少抗生素引起的抗菌药物耐药性）旨在提高人们对日益严峻的挑战的认识和理解，并促进合理使用抗生素治疗急性、非复杂性和自限性感染。方法 本研究是 Arena 研究过程评估的一部分。对参与 Arena 研究的医生进行了有目的地抽样调查，以确定与初级保健医生在为急性非复杂性感染开抗生素处方时的决策相关因素。生成的数据被录音。假名逐字记录是使用预定义的框架进行编码的。双重过程理论用于提供对导致不合理处方决策的个人健康专业因素的理解。结果 基于医学和非医学考虑，医生养成了抗生素处方决策习惯。他们承认，在诊断、预后、护理连续性、患者期望以及不了解患者的情况下，对于急性、非复杂性感染的抗生素处方不足。教育工作使医生能够推翻习惯性处方。理论驱动的模型提供了关于不合理的处方决策如何发生的透明度，并通过教育努力提供新的经验和新的可识别模式来建议补救措施。结论 教育干预只有在抗生素处方方面产生积极理性而非基于常规的决策时，才可能改变处方行为。 试用注册ISRCTN，ISRCTN58150046。