Exploring general practitioners’ perception of the value of natural history information and their awareness and use of guidelines’ resources to support antibiotic prescribing for self-limiting infections: a qualitative study in Australian general practice

Abstract

Background The newest version of the Therapeutic Guidelines’ antibiotic chapter introduced patient- and clinician-facing resources to support decision-making about antibiotic use for self-limiting infections. It is unclear whether general practitioners (GPs) are aware of and use these resources, including the natural history information they contain. We explored GPs’ perceptions of the value and their use of natural history information, and their use of the Therapeutic Guidelines’ resources (summary table, discussion boxes, decision aids) to support antibiotic decision-making. Methods Semi-structured interviews with 21 Australian GPs were conducted. Interviews were recorded, transcribed and thematically analysed by two independent researchers. Results Four themes emerged: (1) GPs perceive natural history information as valuable in consultations for self-limiting conditions and use it for a range of purposes, but desire specific information for infectious and non-infectious conditions; (2) GPs’ reasons for using patient-facing resources were manifold, including managing patients’ expectations for antibiotics, legitimising the decision not to provide antibiotics and as a prescription substitute; (3) the guidelines are a useful and important educational resource, but typically not consulted at the time of deciding whether to prescribe antibiotics; and (4) experience and attitude towards shared decision-making and looking up information during consultations influenced whether GPs involved patients in decision-making and used a decision aid. Conclusions GPs perceived natural history information to be valuable in discussions about antibiotic use for self-limiting conditions. Patient and clinician resources were generally perceived as useful, although reasons for use varied, and a few barriers to use were reported.

Mapping the evidence about the natural history of acute infections commonly seen in primary care and managed with antibiotics: a scoping review

“…However, this information is missing in about 40% of guidelines [20], and sometimes the information provided in guidelines is not evidence-based [24]. In a recent qualitative study with Australian general practitioners, they identi ed the value of knowing natural history evidence and using it in consultations, but felt illprepared to do so without ready access to it [51]. A study of UK primary care patients found that natural history information is highly desired, but is the most common unmet need in a consultation [52].…”