Psychosocial determinants of physician acceptance toward an antimicrobial stewardship program and its computerized decision support system in an acute care tertiary hospital

Objectives Antimicrobial stewardship programs (ASPs) often employ multipronged strategies, including Computerized Decision Support Systems (CDSSs), to promote appropriate prescribing. Physicians are key determinants of program effectiveness, yet little is known about their attitudes towards these interventions. We aimed to explore hospital physicians' perceptions of and attitudes toward ASPs and CDSSs using a focus group discussion (FGD) approach. Methods We recruited physicians from one large tertiary teaching hospital where an ASP and CDSS were available, by purposive sampling and snowballing. Study participants were junior physicians (house officers and medical officers), and senior physicians (consultants who supervise the junior physicians and lead the clinical teams). FGDs for junior and senior physicians were conducted separately using the same question guide. FGDs were audio‐recorded and transcripts independently and systematically coded with subsequent adjudication. Major themes on facilitators and barriers to acceptance of ASPs were extracted. FGDs and coding occurred concurrently. Data analysis and interpretation were consistent with a grounded theory approach. Results Twenty‐nine junior and eight senior physicians participated in six and two FGDs, respectively. Theme saturation was achieved. Two themes reflected facilitators for ASP acceptance: (1) helpfulness of ASP strategies; and (2) ASP team members' proactive contact, both of which guided physician antibiotic prescribing. Four themes identified barriers: (1) the primary team's clinical judgment is of utmost importance; (2) the consultant makes the final decision; (3) lack of awareness of ASP strategies/CDSS; and (4) perceived complexity of the CDSS. Conclusion Communication, education, and medical hierarchy influence ASP acceptance by physicians. Future research is needed to identify best approaches to enhance collaboration between physicians and their ASP teams to enhance ASP/CDSS acceptance.