“I'm Dr JekyllandMr Hyde”: Are GPs’ antibiotic prescribing patterns contextually dependent? A qualitative focus group study

Abstract

ObjectiveTo explore factors and circumstances contributing to prudent antibiotic prescribing for respiratory tract infections in primary care.DesignTwo focus groups representing rural and urban areas. A semi-structured interview guide with open-ended questions and an editing analysis style was used. They were examined to identify meaning units that were sorted into categories in an iterative process throughout the analysis.SettingPrimary health care in two counties in southern Sweden.SubjectsTwo groups including seven and six general practitioners (GPs) respectively, men and women of different ages with different professional experiences.Main outcome measuresExploration of categories, determination of themes, construction of models.ResultsThe decision to prescribe antibiotics takes place in the encounter between GP and patient, initially characterized by harmony or fight and the subsequent process by collaboration or negotiation, resulting in agreement, compromise, or disagreement. Several factors influence the meeting and contribute to enhancing the conditions for rational prescribing. These conditions are connected to the GP, the relationship, and the setting; organization as well as professional culture. The findings indicate synergies between the factors, and that one factor can sometimes compensate for lack of another. Continuity and mutual trust can make a brief consultation successful, but lack of continuity can eliminate the effects of knowledge and professional skills.ConclusionsThe findings emphasize the importance of the encounter between the GP and the patient for prudent antibiotic prescribing. Furthermore, the importance of an appropriate organization of primary care, which promotes continuity and encourages professional autonomy, is demonstrated.

Factors affecting inappropriate prescription of antibiotics and the emergence of antibiotic resistance in patients in primary health care

“…Fear and self-interest of physicians are confirmed as factors that influence the prescribing of antibiotics in other similar studies (24)(25)(26)(27). In our study, it was also shown that physicians have fear of treating patients who are emergent cases and who have another doctor as referring physician.…”

Antibiotic knowledge, attitudes and behaviours of Albanian health care professionals and patients – a qualitative interview study

“…This was supported by the results, which showed that some of the HCPs lacked pharmacological knowledge about ABs. Hence, physicians in other countries appear to disagree more often with their patients when prescribing ABs, and they then try to negotiate with patients to find a solution, than what was observed in this study [22]. …”

“…Despite the fact that physicians and community pharmacists are the legal and professional gatekeepers to patients’ access to ABs, the influence of patients on for example physicians’ AB prescribing practices has been demonstrated in previous studies [7, 22]. Therefore, it was considered important to incorporate these groups in this study.…”

Understanding the delayed prescribing of antibiotics for respiratory tract infection in primary care: a qualitative analysis

“…22 Qualitative research conducted in other countries has demonstrated similar findings to the current study. [27][28][29][30] Evidence suggests that GP prescribing decisions depend on the interaction with the patient and other influencing factors, such as GP characteristics and continuity of care, mutual trust, and flexibility with the patient. 30 GPs interviewed for the current study also saw prescribing as a negotiation tool; however, some did not agree with the delayed prescribing approach as they found it to be contradictory and felt patients ought to have less autonomy.…”

“…30 GPs found that having consistencies in prescribing behaviours throughout the primary care centre, as well as the use of local professional discussions and exchange of experience that facilitates their prescribing practice. This emphasises the call for wider policy implementation and open discussion within and between practices within CCGs, to enable a more consistent rate of prescribing around the UK.…”