General practitioners’ accounts of negotiating antibiotic prescribing decisions with patients: a qualitative study on what influences antibiotic prescribing in low, medium and high prescribing practices

Abstract

BackgroundAntimicrobial resistance (AMR) is high on the UK public health policy agenda, and poses challenges to patient safety and the provision of health services. Widespread prescribing of antibiotics is thought to increase AMR, and mostly takes place in primary medical care. However, prescribing rates vary substantially between general practices. The aim of this study was to understand contextual factors related to general practitioners’ (GPs) antibiotic prescribing behaviour in low, high, and around the mean (medium) prescribing primary care practices.MethodsQualitative semi-structured interviews were conducted with 41 GPs working in North-West England. Participants were purposively sampled from practices with low, medium, and high antibiotic prescribing rates adjusted for the number and characteristics of patients registered in a practice. The interviews were analysed thematically.ResultsThis study found that optimizing antibiotic prescribing creates tensions for GPs, particularly in doctor-patient communication during a consultation. GPs balanced patient expectations and their own decision-making in their communication. When not prescribing antibiotics, GPs reported the need for supportive mechanisms, such as regular practice meetings, within the practice, and in the wider healthcare system (e.g. longer consultation times). In low prescribing practices, GPs reported that increasing dialogue with colleagues, having consistent patterns of prescribing within the practice, supportive practice policies, and enough resources such as consultation time were important supports when not prescribing antibiotics.ConclusionsInsight into GPs’ negotiations with patient and public health demands, and consistent and supportive practice-level policies can help support prudent antibiotic prescribing among primary care practices.

Antibiotic use and deprivation: an analysis of Welsh primary care antibiotic prescribing data by socioeconomic status

“…10 17 Prescribers experience and confidence, as well as system factors, contribute to variation in antibiotic prescribing. 36 However, the ongoing unexplained variation found in our study and previous studies suggests the need for further antibiotic stewardship activities to reduce the unnecessary use of antibiotics that is driving antibiotic resistance.…”

Primary care physicians’ attitudes and perceptions towards antibiotic resistance and outpatient antibiotic stewardship in the USA: a qualitative study

“…These findings are consistent with previous research on perceptions of drivers of outpatient antibiotic prescribing. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] In particular, the perception of patient demand as a driving force behind inappropriate prescribing practices continues to be a consistent finding across studies both in the USA and other countries. Similar perceptions have also been documented among inpatient physicians who believe that prescribers outside of hospitals are primarily responsible for antibiotic overuse and antibiotic resistance, underscoring the value for individual feedback on prescribing patterns to help these physicians recognise the need for antibiotic stewardship in their practice.…”

“…Many studies, including those from the USA and Europe, have shown that physicians consider patient demand and prescribing of other physicians to be primary drivers of inappropriate antibiotic prescribing. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] In order to counteract these drivers of inappropriate prescribing, physicians have highlighted a need for improved public education around antibiotic resistance and the need for appropriate prescribing. 20-23 26 Additionally, studies from USA and European countries have shown that physician time constraints, fear of undertreating patients due to diagnostic uncertainty, and certain clinical factors are also seen as drivers of inappropriate prescribing.…”

“… 11–25 In order to counteract these drivers of inappropriate prescribing, physicians have highlighted a need for improved public education around antibiotic resistance and the need for appropriate prescribing. 20–23 26 Additionally, studies from USA and European countries have shown that physician time constraints, fear of undertreating patients due to diagnostic uncertainty, and certain clinical factors are also seen as drivers of inappropriate prescribing. 11–13 15–17 19–21 23 24 27 28 …”

Autonomy, power dynamics and antibiotic use in primary healthcare: A qualitative study

“…This should however be accompanied by professionals’ training on how to share power and promote horizontal communication and relationships with service users [ 96 ]. Besides, it is important to consider structural limitations and other barriers already identified in previous research, such as time constraints in primary healthcare consultations [ 97 ] and limitations that healthcare professionals encounter to negotiate antibiotic prescribing decisions with service users [ 98 ].…”