Figure 1

Conceptual model of factors that influence antibiotic prescribing in nursing homes and residential care homes in the Netherlands. The model shows that the clinical situation and advance care plans constitute the basis of the antibiotic prescribing decision. The other four categories can exert a direct influence on this prescribing decision, or an indirect influence via other categories. The clinical situation can influence the use of diagnostic resources (e.g. no X-ray when a patient is severely ill) and vice versa (e.g. less information about the clinical situation when no diagnostic resources are used). The use of diagnostic resources can also be influenced by environmental factors (e.g. availability of on-site diagnostic resources). Physicians’ perceived risks can be influenced by the clinical situation (e.g. higher perceived risk of non-treatment if a patient is severely ill), the use of diagnostic resources (e.g. more uncertainty if no diagnostic resources are used), others (e.g. pressure from patients), and the environment (e.g. different risk perceptions when on call). The influence of others can be affected by the environment (e.g. the influence of nursing staff may differ when a consultation is by telephone compared to a physical consultation).