Adherence to guidelines on antibiotic treatment for respiratory tract infections in various categories of physicians: a retrospective cross-sectional study of data from electronic patient records

Abstract

ObjectiveTo study how prescription patterns concerning respiratory tract infections differ between interns, residents, younger general practitioners (GPs), older GPs and locums.DesignRetrospective study of structured data from electronic patient records.SettingData were obtained from 53 health centres and 3 out-of-hours units in Jönköping County, Sweden, through their common electronic medical record database.ParticipantsAll physicians working in primary care during the 2-year study period (1 November 2010 to 31 October 2012).Outcome measuresPhysicians’ adherence to current guidelines for respiratory tract infections regarding the use of antibiotics.ResultsWe found considerable differences in prescribing patterns between physician categories. The recommended antibiotic, phenoxymethylpenicillin, was more often prescribed by interns, residents and younger GPs, while older GPs and locums to a higher degree prescribed broad-spectrum antibiotics. The greatest differences were seen when the recommendation in guidelines was to refrain from antibiotics, as for acute bronchitis. Interns and residents most often followed guidelines, while compliance in descending order was: young GPs, older GPs and locums. We also noticed that male doctors were somewhat overall more restrictive with antibiotics than female doctors.ConclusionsIn general, primary care doctors followed national guidelines on choice of antibiotics when treating respiratory tract infections in children but to a lesser degree when treating adults. Refraining from antibiotics seems harder. Adherence to national guidelines could be improved, especially for acute bronchitis and pneumonia. This was especially true for older GPs and locums whose prescription patterns were distant from the prevailing guidelines.

Ambulatory Care Visits to Pediatricians in Taiwan: A Nationwide Analysis

“…In the United States, the prescriptions of antibiotics for children with URI has decreased in these years [ 26 , 27 , 28 ]. Intervention by strict criteria, enforcement of national guidelines and community-wide campaign could have influences in antibiotics prescribing for children [ 29 , 30 , 31 ]. However, the low overall consumption of antibiotics is by no means an indicator of appropriate pediatric antibiotic prescribing [ 12 ].…”

Antibiotic prescribing practice and adherence to guidelines in primary care in the Cape Town Metro District, South Africa

“…[7][8][9][10][11][12][13] Studies have shown poor guideline adherence for respiratory problems, [7][8][9][10] urinary tract infections, [11,12] tonsillitis [13] and acute diarrhoea. [10] Other variables associated with poor adherence include seniority of the clinician, [14] prescriber workload, [15] patient age [8,14] and area-level socioeconomic status. [8] Using antibiotics incorrectly and inappropriately by not following guidelines can contribute to the development of resistance, as well as poor clinical outcomes including patient morbidity.…”

Overview of preventive practices provided by primary care physicians: A cross-sectional study in Switzerland and France

“…Indeed, several authors have shown that older PCPs tend to have lower adherence to recent guidelines. [ 34 , 35 ]…”