Dealing with patient expectations regarding the prescription of antibiotics in ambulatory care in Germany: A qualitative analysis

Abstract

Background Antibiotics prescription rates are relatively high in primary care in Germany. Patients’ expectations have frequently been mentioned as reason for high prescription rates. The extent to which patients’ expectations play a role and the strategies that physicians use to deal with these expectations and prevent non-indicated prescriptions in acute, uncomplicated infections are the subject of this paper.Methods In this qualitative study, twenty-seven semi-structured interviews with physicians were conducted in 2018. Data were audiotaped, pseudonymized and transcribed verbatim. The analysis was based on a framework analysis according to the Tailored Implementation in Chronic Diseases (TICD) checklist, and was expanded for deeper analysis and completed with the Behavior Change Techniques (BCT) taxonomy. Results The data revealed that patients’ expectations regarding the prescription of antibiotics can play an important role, although they may be ignored by physicians. If physicians respond to patients’ expectations, they use various strategies to deal and communicate with patients. Successful communication is more often achieved, if the physician takes sufficient time with the patient and if this results in a cooperative conversation. Thus, patients get informed about antibiotics and antimicrobial resistance, and it is possible to discuss alternative treatments. Seven strategies from the BCT taxonomy were mentioned by physicians in this study.Conclusion Constructive physician-patient communication was key to reducing antibiotic prescribing. The range of behavior change techniques mentioned by physicians was relatively limited and the use of a wider range of strategies could be the focus of future implementation strategies. Trial registration: ISRCTN, ISRCTN58150046. Registered 24 August 2017. Keywords Antibiotics prescription, patient expectations, physician-patient communication, patient education, communication strategies, behavior change technique, qualitative research