Clinicians’ Views and Experiences of Interventions to Enhance the Quality of Antibiotic Prescribing for Acute Respiratory Tract Infections

Abstract

BACKGROUND: Evidence shows a high rate of unnecessary antibiotic prescriptions in primary care in Europe and the United States. Given the costs of widespread use and associated antibiotic resistance, reducing inappropriate use is a public health priority. OBJECTIVE: We aimed to explore clinicians' experiences of training in communication skills and use of a patient booklet and/or a C-reactive protein (CRP) point-of-care test to reduce antibiotic prescribing for acute respiratory tract infections (RTIs). DESIGN: We used a qualitative research approach, interviewing clinicians who participated in a randomised controlled trial (RCT) testing two contrasting interventions. PARTICIPANTS: General practice clinicians in Belgium, England, The Netherlands, Poland, Spain and Wales participated in the study. APPROACH: Sixty-six semi-structured interviews were transcribed verbatim, translated into English where necessary, and analysed using thematic and framework analysis. KEY RESULTS: Clinicians from all countries attributed benefits for themselves and their patients to using both interventions. Clinicians reported that the communication skills training and use of the patient booklet gave them greater confidence in addressing patient expectations for an antibiotic by providing answers to common questions and supporting the clinician's own explanations. Clinicians felt the booklet could be used for a variety of patients and for different types of infections. The CRP test was viewed as a tool to decrease diagnostic uncertainty, to support non-prescription decisions, and to reassure patients, but was only necessary when clinicians were uncertain about the need for antibiotics. CONCLUSION: Providing clinicians with training and support tools for use in practice was received positively and was valued by clinicians across countries. Interventions seemed to have influenced behaviour by increasing clinician knowledge about illness severity and prescribing, increasing confidence in making non-prescribing decisions when antibiotics were unnecessary, and enabling clinicians to anticipate positive outcomes when making such decisions. Addressing such determinants of behaviour change enabled interventions to be relevant for clinicians working across different contexts.

Point-of-care CRP testing in the diagnosis of pneumonia in adults

“…if the illness was still in its early stages and the CRP might not be initially raised) that could result in a lack of necessary antibiotic treatment 2,9,21,24…”

How French general practitioners manage and prevent recurrent respiratory tract infections in children: the SOURIRRE survey

“…A study of medicine used in children in Germany recently reported that 13.8% of participants had used drugs to treat a common cold or an URTI in the previous 7 days; half of them took prescribed medications, of which antibiotics represented 11.5% 14. The reasons for antibiotic over-prescription are numerous 15,16. One of them is the difficulty in identifying children at risk of poor outcomes.…”

Point-of-care testing for C-reactive protein in acute cough presentations

“…Despite these shortfalls clinicians working in primary care with POCT for CRP held positive views about using CRP to guide clinical decision making (Wood et al, 2011). This was further reported by Anthierens et al (2014) and Cals et al (2009b) where clinicians felt that the CRP test decreased clinical uncertainty and supported nonprescribing decisions.…”