Driving factors and barriers to irrational antibiotic prescribing in Pakistan: a qualitative study of physicians', pharmacists' and nurses' perspectives in public and private hospitals.

Abstract

Irrational prescribing is a major global health concern, contributing significantly to increased morbidity, mortality and antimicrobial resistance (AMR). Despite existing knowledge and awareness, irrational antibiotic use remains prevalent among healthcare professionals. This qualitative study aimed to explore the contributing factors to irrational antibiotic prescribing, understand healthcare professionals' perceptions, identify barriers to rational use and gather suggestions for improving rational antibiotic use. A qualitative study using semi-structured interviews was conducted with participants. A total of 60 healthcare professionals (20 physicians, 20 pharmacists and 20 nurses) participated after providing verbal consent. Semi-structured interviews were conducted with healthcare professionals across various clinical settings in Pakistan until data saturation was reached. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used to ensure transparent reporting. An inductive thematic analysis approach was employed and themes and subthemes were developed from the data. The findings revealed a generally good understanding of irrational prescribing. Contributing factors included prescriber-related issues, patient expectations, weak regulatory oversight and underutilisation of pharmacists. Key barriers identified were financial constraints, lack of awareness and insufficient resources. Suggestions for improvement included regular audits, public awareness campaigns, an integrated healthcare system, interprofessional collaboration, drug utilisation reviews, adverse drug reaction reporting, standardising hospital policies and strengthening regulatory frameworks. This study highlights critical factors and barriers contributing to irrational antibiotic prescribing and presents practical suggestions to improve rational use. Implementing evidence-based approaches, updating clinical guidelines, and promoting awareness among healthcare professionals are essential steps toward improving prescribing practices and combating AMR.