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Wollny A, Altiner A, Garbe K, Klingenberg A, Kaufmann-Kolle P, Köppen M, Kamradt M, Poß-Doering R, Wensing M, Leyh M, Voss A, Feldmeier G. [Acute respiratory tract infections and antibiotic prescriptions: What are patients' expectations?]. Laryngorhinootologie 2023; 102:203-211. [PMID: 36543222 PMCID: PMC9977567 DOI: 10.1055/a-1949-3397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The use of antibiotics in human medicine is partly responsible for the global increase in antibiotic resistance. Significant reductions in antibiotic prescribing were realised through educational campaigns, communication training and prescribing feedback. Based on data from the cluster-randomised CHANGE-3 trial, the present analysis focuses on the question of patient expectations for an antibiotic in acute respiratory infections. METHODS 106 of 114 General Practitioner (GP) practices in Baden-Württemberg and Mecklenburg-Western Pomerania took part in the study. 4736 patients who visited the practices with acute respiratory infections from October 2018 to May 2019 filled out a questionnaire after the doctor's consultation. The analysis was descriptive. RESULTS 16.7 % of patients with acute respiratory infections reported receiving antibiotics from their GP. 13.3 % of patients had hoped for an antibiotic and 5.5 % stated that they had asked their GP for an antibiotic prescription. The lowest prescription rate for antibiotics was reported by patients who had received a diagnosis of influenza from their GP. With specific diagnoses differentiated from uncomplicated respiratory tract infection, an increase in both the number of antibiotics hoped for and the number of antibiotics prescribed was observed. DISCUSSION Patients still receive antibiotics more often than they actually hope for. On the part of GPs, prescriptions may still be written because of perceived pressure from patients, but this is not reflected in patient expectations. In addition to dealing openly with patients' expectations, strengthening patients' health literacy, mindful doctor-patient communication and offered opportunities for re-presentation in the case of specific diagnoses could further reduce the perceived pressure on GPs.
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Affiliation(s)
- Anja Wollny
- Institut für Allgemeinmedizin, Universitätsmedizin Rostock, Rostock, GERMANY
- Korrespondenzadresse Dr. phil. Anja Wollny Institut für Allgemeinmedizin, Universitätsmedizin RostockDoberaner Straße 14218057 RostockGERMANY
| | - Attila Altiner
- Institut für Allgemeinmedizin, Universitätsmedizin Rostock, Rostock, GERMANY
| | - Katharina Garbe
- Institut für Allgemeinmedizin, Universitätsmedizin Rostock, Rostock, GERMANY
| | - Anja Klingenberg
- Insitut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH (aQua-Institut), Göttingen,
| | - Petra Kaufmann-Kolle
- Insitut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH (aQua-Institut), Göttingen,
| | - Martina Köppen
- Insitut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH (aQua-Institut), Göttingen,
| | - Martina Kamradt
- Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg,
| | - Regina Poß-Doering
- Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg,
| | - Michel Wensing
- Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg,
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Post-consultation acute respiratory tract infection recovery: a latent class-informed analysis of individual patient data. Br J Gen Pract 2023; 73:e196-e203. [PMID: 36823057 PMCID: PMC9975977 DOI: 10.3399/bjgp.2022.0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 11/11/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is a lack of evidence regarding post-consultation symptom trajectories for patients with respiratory tract infections (RTIs) and whether patient characteristics can be used to predict illness duration. AIM To describe symptom trajectories in patients with RTIs, and assess baseline characteristics and adverse events associated with trajectories. DESIGN AND SETTING The study included data about 9103 adults and children from 12 primary care studies. METHOD A latent class-informed regression analysis of individual patient data from randomised controlled trials and observational cohort studies was undertaken. Post-consultation symptom trajectory (severity and duration), re-consultation with same or worsening illness, and admission to hospital were assessed. RESULTS In total, 90% of participants recovered from all symptoms by 28 days, regardless of antibiotic prescribing strategy (none, immediate, and delayed antibiotics). For studies of RTI with cough as a dominant symptom (n = 5314), four trajectories were identified: 'rapid (6 days)' (90% of participants recovered within 6 days) in 52.0%; 'intermediate (10 days)' (28.9%); 'slow progressive improvement (27 days)' (12.5%); and 'slow improvement with initial high symptom burden (27 days)' (6.6%). For cough, being aged 16-64 years (odds ratio [OR] 2.57, 95% confidence interval [CI] = 1.72 to 3.85 compared with <16 years), higher presenting illness baseline severity (OR 1.51, 95% CI = 1.12 to 2.03), presence of lung disease (OR 1.78, 95% CI = 1.44 to 2.21), and median and above illness duration before consultation (≥7 days) (OR 1.99, 95% CI = 1.68 to 2.37) were associated with slower recovery (>10 days) compared with faster recovery (≤10 days). Re-consultations and admissions to hospital for cough were higher in those with slower recovery (ORs: 2.15, 95% CI = 1.78 to 2.60 and 7.42, 95% CI = 3.49 to 15.78, respectively). CONCLUSION Older patients presenting with more severe, longer pre-consultation symptoms and chronic lung disease should be advised they are more likely to experience longer post-consultation illness durations, and that recovery rates are similar with and without antibiotics.
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Wollny A, Altiner A, Garbe K, Klingenberg A, Kaufmann-Kolle P, Köppen M, Kamradt M, Poß-Doering R, Wensing M, Leyh M, Voss A, Feldmeier G. [Acute respiratory tract infections and antibiotic prescriptions: What are patients' expectations?]. Dtsch Med Wochenschr 2022; 147:e82-e90. [PMID: 35973750 PMCID: PMC9451922 DOI: 10.1055/a-1871-7626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Einleitung
Der Einsatz von Antibiotika in der Humanmedizin ist für den globalen Anstieg der Antibiotika-Resistenzen mitverantwortlich. Aufklärungskampagnen, Kommunikationstrainings und Verordnungsfeedback führten zu einer deutlichen Reduktion der Antibiotika-Verordnungen. Basierend auf Daten der Cluster-randomisierten Studie CHANGE-3 steht in der vorliegenden Analyse die Frage nach der patientenseitigen Erwartungshaltung für ein Antibiotikum bei akuten Atemwegsinfektionen im Mittelpunkt.
Methoden
An der Untersuchung beteiligten sich 106 von 114 Hausarztpraxen in Baden-Württemberg und Mecklenburg-Vorpommern. 4736 Patient*innen, die von Oktober 2018 bis Mai 2019 mit akuten Atemwegsinfekten in die Praxen kamen, füllten nach der Arztkonsultation einen Fragebogen aus. Die Analyse erfolgte deskriptiv.
Ergebnisse
16,7 % der Patient*innen mit akuten Atemwegsinfekten gaben an, Antibiotika von ihren Hausärzt*innen erhalten zu haben. 13,3 % der Patient*innen hatten ein Antibiotikum erhofft und 5,5 % gaben an, die/den Hausärzt*in darum gebeten zu haben. Der geringste Anteil an Antibiotika-Verordnungen entfiel auf Patient*innen, die die Diagnose eines grippalen Infekts vom/von der Ärzt*in kommuniziert bekamen. Mit spezifischen Diagnosen in Abgrenzung zum unkomplizierten Atemwegsinfekt wurde ein Anstieg sowohl der Anzahl der erhofften als auch der verordneten Antibiotika beobachtet.
Diskussion
Patient*innen erhalten nach wie vor häufiger Antibiotika, als es von ihnen erhofft wird. Auf Seiten der Hausärzt*innen könnten die Verordnungen nach wie vor aufgrund eines gefühlten Drucks durch die Patient*innen stattfinden, die sich jedoch so nicht in der Erwartungshaltung der Patient*innen widerspiegelt. Neben einer offenen Exploration der Erwartungshaltung der Patient*innen könnten die Stärkung ihrer Gesundheitskompetenz, eine achtsame Arzt-Patienten-Kommunikation und angebotene Wiedervorstellungsmöglichkeiten bei spezifischen Diagnosen den gefühlten Druck auf Seiten der Ärzt*innen weiter reduzieren.
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Affiliation(s)
- Anja Wollny
- Institut für Allgemeinmedizin, Universitätsmedizin Rostock
| | - Attila Altiner
- Institut für Allgemeinmedizin, Universitätsmedizin Rostock.,Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg
| | | | - Anja Klingenberg
- Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH (aQua-Institut), Göttingen
| | - Petra Kaufmann-Kolle
- Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH (aQua-Institut), Göttingen
| | - Martina Köppen
- Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH (aQua-Institut), Göttingen
| | - Martina Kamradt
- Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg
| | - Regina Poß-Doering
- Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg
| | - Michel Wensing
- Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg
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Hayes CV, Mahon B, Sides E, Allison R, Lecky DM, McNulty CAM. Empowering Patients to Self-Manage Common Infections: Qualitative Study Informing the Development of an Evidence-Based Patient Information Leaflet. Antibiotics (Basel) 2021; 10:1113. [PMID: 34572695 PMCID: PMC8464808 DOI: 10.3390/antibiotics10091113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 02/07/2023] Open
Abstract
Common self-limiting infections can be self-managed by patients, potentially reducing consultations and unnecessary antibiotic use. This qualitative study informed by the Theoretical Domains Framework (TDF) aimed to explore healthcare professionals' (HCPs) and patients' needs on provision of self-care and safety-netting advice for common infections. Twenty-seven patients and seven HCPs participated in semi-structured focus groups (FGs) and interviews. An information leaflet was iteratively developed and reviewed by participants in interviews and FGs, and an additional 5 HCPs, and 25 patients (identifying from minority ethnic groups) via online questionnaires. Qualitative data were analysed thematically, double-coded, and mapped to the TDF. Participants required information on symptom duration, safety netting, self-care, and antibiotics. Patients felt confident to self-care and were averse to consulting with HCPs unnecessarily but struggled to assess symptom severity. Patients reported seeking help for children or elderly dependents earlier. HCPs' concerns included patients' attitudes and a lack of available monitoring of advice given to patients. Participants believed community pharmacy should be the first place that patients seek advice on common infections. The patient information leaflet on common infections should be used in primary care and community pharmacy to support patients to self-manage symptoms and determine when further help is required.
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Affiliation(s)
- Catherine V. Hayes
- Primary Care and Interventions Unit, Public Health England, Gloucester GL1 1DQ, UK; (B.M.); (E.S.); (R.A.); (D.M.L.); (C.A.M.M.)
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De Vocht K, Debie T, Bastiaens H, Anthierens S. The use of paracetamol for first-line treatment of acute sore throat. A descriptive generic qualitative study of GPs and patients. Eur J Gen Pract 2021; 27:60-67. [PMID: 33949255 PMCID: PMC8118443 DOI: 10.1080/13814788.2021.1912730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Paracetamol is recommended as first-line treatment for an acute sore throat. However, in primary care, antibiotics are still frequently prescribed as first-line management for sore throat. Objectives We aimed to explore the views and experiences of general practitioners (GPs) and patients regarding paracetamol for sore throat to understand why guidelines are often not adhered to. Methods A descriptive qualitative study with semi-structured interviews was conducted with a purposive sample of eight GPs and nine patients in Antwerp (Belgium). Data was analysed using thematic content analysis. Results The mean age of GPs was 42.4 years and of patients 51.4 years. Patients want reassurance and pain relief. Many patients do not self-manage their acute sore throat with paracetamol before consulting their GP. GPs often wrongly assume that the patient has already used pain relief without actually exploring this. Patients who do use paracetamol, do not know how to use it effectively. This leads to the perception and beliefs that it is insufficient to treat acute sore throat and when prescribed will lead to dissatisfaction. Patients generally accept the GP’s recommended treatment when given a thorough explanation, since they trust their GP’s expertise. Conclusion GPs play a major role in educating patients about paracetamol as effective pain-relieving treatment in acute sore throat. By actively exploring the patients’ ideas, concerns and expectations (ICE), patients’ satisfaction and guideline adherence could be improved.
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Affiliation(s)
- Kimberley De Vocht
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Tycho Debie
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Hilde Bastiaens
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Sibyl Anthierens
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
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Stuart B, Hounkpatin H, Becque T, Yao G, Zhu S, Alonso-Coello P, Altiner A, Arroll B, Böhning D, Bostock J, Bucher HC, Chao J, de la Poza M, Francis N, Gillespie D, Hay AD, Kenealy T, Löffler C, McCormick DP, Mas-Dalmau G, Muñoz L, Samuel K, Moore M, Little P. Delayed antibiotic prescribing for respiratory tract infections: individual patient data meta-analysis. BMJ 2021; 373:n808. [PMID: 33910882 PMCID: PMC8080136 DOI: 10.1136/bmj.n808] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To assess the overall effect of delayed antibiotic prescribing on average symptom severity for patients with respiratory tract infections in the community, and to identify any factors modifying this effect. DESIGN Systematic review and individual patient data meta-analysis. DATA SOURCES Cochrane Central Register of Controlled Trials, Ovid Medline, Ovid Embase, EBSCO CINAHL Plus, and Web of Science. ELIGIBILITY CRITERIA FOR STUDY SELECTION Randomised controlled trials and observational cohort studies in a community setting that allowed comparison between delayed versus no antibiotic prescribing, and delayed versus immediate antibiotic prescribing. MAIN OUTCOME MEASURES The primary outcome was the average symptom severity two to four days after the initial consultation measured on a seven item scale (ranging from normal to as bad as could be). Secondary outcomes were duration of illness after the initial consultation, complications resulting in admission to hospital or death, reconsultation with the same or worsening illness, and patient satisfaction rated on a Likert scale. RESULTS Data were obtained from nine randomised controlled trials and four observational studies, totalling 55 682 patients. No difference was found in follow-up symptom severity (seven point scale) for delayed versus immediate antibiotics (adjusted mean difference -0.003, 95% confidence interval -0.12 to 0.11) or delayed versus no antibiotics (0.02, -0.11 to 0.15). Symptom duration was slightly longer in those given delayed versus immediate antibiotics (11.4 v 10.9 days), but was similar for delayed versus no antibiotics. Complications resulting in hospital admission or death were lower with delayed versus no antibiotics (odds ratio 0.62, 95% confidence interval 0.30 to 1.27) and delayed versus immediate antibiotics (0.78, 0.53 to 1.13). A significant reduction in reconsultation rates (odds ratio 0.72, 95% confidence interval 0.60 to 0.87) and an increase in patient satisfaction (adjusted mean difference 0.09, 0.06 to 0.11) were observed in delayed versus no antibiotics. The effect of delayed versus immediate antibiotics and delayed versus no antibiotics was not modified by previous duration of illness, fever, comorbidity, or severity of symptoms. Children younger than 5 years had a slightly higher follow-up symptom severity with delayed antibiotics than with immediate antibiotics (adjusted mean difference 0.10, 95% confidence interval 0.03 to 0.18), but no increased severity was found in the older age group. CONCLUSIONS Delayed antibiotic prescribing is a safe and effective strategy for most patients, including those in higher risk subgroups. Delayed prescribing was associated with similar symptom duration as no antibiotic prescribing and is unlikely to lead to poorer symptom control than immediate antibiotic prescribing. Delayed prescribing could reduce reconsultation rates and is unlikely to be associated with an increase in symptoms or illness duration, except in young children. STUDY REGISTRATION PROSPERO CRD42018079400.
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Affiliation(s)
- Beth Stuart
- Academic Unit of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Hilda Hounkpatin
- Academic Unit of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Taeko Becque
- Academic Unit of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Guiqing Yao
- Biostatistics Research Group, Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Shihua Zhu
- Academic Unit of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau-CIBERESP), Barcelona, Spain
| | - Attila Altiner
- Institute of General Practice, Rostock University Medical Center, Rostock, Germany
| | - Bruce Arroll
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Dankmar Böhning
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Jennifer Bostock
- Division of Health and Social Care Research, King's College London, London, UK
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics (CEB), University Hospital Basel and University of Basel, Switzerland
| | - Jennifer Chao
- Pediatric Emergency Medicine, State University of New York Downstate, Brooklyn, New York, USA
| | - Mariam de la Poza
- Institut Català de la Salut, CAP Doctor Carles Ribas, Foc 112, Barcelona, Spain
| | - Nick Francis
- Academic Unit of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - David Gillespie
- Centre for Trials Research, School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Timothy Kenealy
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Christin Löffler
- Institute of General Practice, Rostock University Medical Center, Rostock, Germany
| | - David P McCormick
- Department of Pediatrics, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Gemma Mas-Dalmau
- Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Laura Muñoz
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
| | - Kirsty Samuel
- ASPIRE PPI Panel, Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Michael Moore
- Academic Unit of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul Little
- Academic Unit of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
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Alternative approaches to managing respiratory tract infections: a survey of public perceptions. BJGP Open 2021; 5:BJGPO.2020.0124. [PMID: 33293410 PMCID: PMC8170598 DOI: 10.3399/bjgpo.2020.0124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/24/2020] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Respiratory tract infections (RTIs) are a common reason for people to consult in primary care, and contribute to antibiotic overuse and antimicrobial resistance (AMR). Alternative approaches to supporting patients with RTIs may help, but it is important to understand public perceptions about these approaches before they are widely implemented. AIM To describe public perceptions regarding finger-prick testing, back-up antibiotic prescriptions (BUPs), and alternatives to traditional consultations for RTIs, and identify factors associated with favouring these approaches. DESIGN & SETTING Online national survey (HealthWise Wales) with linked primary care health record data. METHOD Survey item response distributions were described. Associations between responses about consultation alternatives, BUP, and finger-prick point-of-care testing (POCT), and potential explanatory variables, were explored using logistic regression. RESULTS A total of 8752 participants completed the survey between 2016 and 2018. The survey found 76.7% (n = 3807/4,966) and 71.2% (n = 3529/4,953) of responders with valid responses were in favour of being able to consult with a pharmacist or nurse in their GP surgery, or with a community pharmacist, respectively. It also showed 92.8% (n = 8034/8659) of responders indicated they would be happy to have a finger-prick test to guide antibiotic prescribing, and 31.8% (n = 2746/8646) indicated they would like to be given a BUP if their clinician thought immediate antibiotics were not required. In addition, 47.4% (n = 2342/4944) and 42.3% (n = 2095/4949) were in favour of having video and email consultations, respectively. Characteristics associated with different response options were identified. CONCLUSION Consulting with pharmacists, using electronic communication tools, and finger-prick testing are widely acceptable approaches. BUP was described as acceptable less often, and is likely to require greater information and support when used.
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Saliba-Gustafsson EA, Nyberg A, Borg MA, Rosales-Klintz S, Stålsby Lundborg C. Barriers and facilitators to prudent antibiotic prescribing for acute respiratory tract infections: A qualitative study with general practitioners in Malta. PLoS One 2021; 16:e0246782. [PMID: 33571265 PMCID: PMC7877739 DOI: 10.1371/journal.pone.0246782] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 01/26/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Antibiotic resistance is a leading global public health concern and antibiotic use is a key driver. Effective interventions are needed to target key stakeholders, including general practitioners (GPs). In Malta, little is known about factors that influence GPs' antibiotic prescribing, making it challenging to implement targeted interventions. We therefore aimed to explore GPs' understanding of antibiotic use and resistance, and describe their perceived barriers and facilitators to prudent antibiotic prescribing for acute respiratory tract infections in Malta. METHODS Face-to-face individual semi-structured interviews were held with a quota sample of 20 GPs in 2014. Interviews were audio recorded and transcribed verbatim, and later analysed iteratively using manifest and latent content analysis. Findings were collated in a socioecological model to depict how GPs as individuals are embedded within larger social systems and contexts, and how each component within this system impacts their prescribing behaviour. FINDINGS We found that GPs' antibiotic prescribing decisions are complex and impacted by numerous barriers and facilitators at the individual, interpersonal, organisational, community, and public policy level. Predominant factors found to impact GPs' antibiotic prescribing included not only intrinsic GP factors such as knowledge, awareness, experience, and misconceptions, but also several external factors. At the interpersonal level, GPs' perceived patient demand and behaviour to be a persistent issue that impacts their prescribing decisions. Similarly, some GPs found pressure from drug reps to be concerning despite being considered an important source of information. Organisational and public policy-level issues such as lack of access to relevant antibiotic prescribing guidelines and current antibiotic resistance data from the community, were also considered major barriers to appropriate antibiotic prescribing. Utilisation of diagnostic testing was found to be low and GPs' perceptions on the introduction of rapid point-of-care tests to support antibiotic prescription decisions, were mixed. CONCLUSION This study revealed the complexity of the antibiotic prescribing decision and the numerous barriers and facilitators that impact it, visualised through a socioecological model. Addressing GPs' antibiotic prescribing practices will require targeted and coordinated implementation activities at all levels to change behaviour and address misconceptions, whilst also improving the physical and social environment. TRIAL REGISTRATION NUMBER NCT03218930; https://clinicaltrials.gov/ct2/show/NCT03218930.
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Affiliation(s)
- Erika A. Saliba-Gustafsson
- Department of Global Public Health, Health Systems and Policy (HSP): Improving Use of Medicines, Karolinska Institutet, Stockholm, Sweden
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, United States of America
| | - Anna Nyberg
- Faculty of Social Sciences, Stockholm University, Stockholm, Sweden
| | - Michael A. Borg
- Department of Infection Prevention and Control, Mater Dei Hospital, Msida, Malta
- Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Senia Rosales-Klintz
- Department of Global Public Health, Health Systems and Policy (HSP): Improving Use of Medicines, Karolinska Institutet, Stockholm, Sweden
- Unit of Surveillance and Response Support (SRS), European Centre for Disease Prevention and Control, Solna, Sweden
| | - Cecilia Stålsby Lundborg
- Department of Global Public Health, Health Systems and Policy (HSP): Improving Use of Medicines, Karolinska Institutet, Stockholm, Sweden
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Medina-Perucha L, García-Sangenís A, Moragas A, Gálvez-Hernández P, Cots JM, Lanau-Roig A, Borràs A, Amo I, Monfà R, Llor C, Berenguera A. Autonomy, power dynamics and antibiotic use in primary healthcare: A qualitative study. PLoS One 2020; 15:e0244432. [PMID: 33338078 PMCID: PMC7748265 DOI: 10.1371/journal.pone.0244432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 12/09/2020] [Indexed: 12/30/2022] Open
Abstract
Antibiotic resistance is a global health concern. Although numerous strategies have tried to reduce inadequate antibiotic prescribing, antibiotics are still prescribed in 60% of acute lower respiratory tract infections (ALRTIs) cases in Catalonia (Spain). This study aims to explore service users' experiences of ALRTIs, the quality and access to healthcare services, and health education. Selective purposive sampling was carried out, based on a prior definition of participant characteristics. These were sex, age, ethnicity, date of the last ALRTI, number of ALRTIs in the last year, and treatments received. Participants with a previous diagnosis of ALRTIs were recruited from three primary health care centres in Barcelona and one in Tarragona. Twenty-nine interviews were conducted between April and June 2019. A content thematic analysis was performed. Three themes were identified: 1) risk perceptions and help-seeking; 2) treatment preferences and antibiotic use; and 3) relationship dynamics and communication with healthcare professionals. Accounts of service users' sense of autonomy towards their health and power dynamics within the healthcare system were apparent. Supporting service users to become reliable, subjective and agentic experts of their health and bodies could help them to voice their healthcare agendas. Power structures embedded within healthcare, political and economic institutions should be challenged so that healthcare services can be co-developed (with service users) and based on service users' autonomy and horizontal relationships. Special consideration should be paid to the intersection of social vulnerabilities. A concordance approach to prescribing could be key to improve the responsible use of antibiotics and to contribute to the prevention of AMR in primary healthcare. The marketisation of health, and the increased demands of private healthcare in Spain due to the financial pressures on public healthcare as a consequence of the financial crisis of 2008 and the COVID-19 pandemic, are a risk for promoting adequate antibiotic prescribing and use. Trial registration The ISAAC-CAT study has been registered in the NCT registry, ID: NCT03931577.
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Affiliation(s)
- Laura Medina-Perucha
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Ana García-Sangenís
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Ana Moragas
- Universitat Rovira i Virgili, Jaume I Health Centre, Institut Català de la Salut, Tarragona, Spain
| | - Pablo Gálvez-Hernández
- Institut Universitari de Pacients (Patients’ University Institut), Universitat Internacional de Catalunya, Barcelona, Spain
- University of Toronto, IHPME-BFON Collaborative PhD Specialization Program in Health Services and Policy Research, Toronto, Ontario, Canada
| | - Josep María Cots
- La Marina Health Centre, Institut Català de la Salut, Associació d’Infermeria Familiar i Comunitària de Catalunya, Barcelona, Spain
| | - Anna Lanau-Roig
- La Marina Health Centre, Institut Català de la Salut, Associació d’Infermeria Familiar i Comunitària de Catalunya, Barcelona, Spain
| | - Alícia Borràs
- Institut Universitari de Pacients (Patients’ University Institut), Universitat Internacional de Catalunya, Barcelona, Spain
- Escola Universitària d'Infermeria, Escoles Universitàries Gimbernat, Universitat Autònoma de Barcelona, Sant Cugat del Vallès, Spain
| | - Isabel Amo
- Institut Universitari de Pacients (Patients’ University Institut), Universitat Internacional de Catalunya, Barcelona, Spain
| | - Ramon Monfà
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Carl Llor
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Via Roma Health Centre, Institut Català de la Salut, Barcelona, Spain
| | - Anna Berenguera
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Departament d'Infermeria, Universitat de Girona, Girona, Spain
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10
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Ghebrehewet S, Shepherd W, Panford-Quainoo E, Shantikumar S, Decraene V, Rajendran R, Kaushal M, Akuffo A, Ayerh D, Amofah G. Implementation of a Delayed Prescribing Model to Reduce Antibiotic Prescribing for Suspected Upper Respiratory Tract Infections in a Hospital Outpatient Department, Ghana. Antibiotics (Basel) 2020; 9:E773. [PMID: 33158038 PMCID: PMC7694150 DOI: 10.3390/antibiotics9110773] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/30/2020] [Accepted: 10/31/2020] [Indexed: 11/16/2022] Open
Abstract
Background: High levels of antimicrobial resistance (AMR) in Ghana require the exploration of new approaches to optimise antimicrobial prescribing. This study aims to establish the feasibility of implementation of different delayed/back-up prescribing models on antimicrobial prescribing for upper respiratory tract infections (URTIs). Methods: This study was part of a quality improvement project at LEKMA Hospital, Ghana, (Dec 2019-Feb 2020). Patients meeting inclusion criteria were assigned to one of four groups (Group 0: No prescription given; Group 1; Patient received post-dated antibiotic prescription; Group 2: Offer of a rapid reassessment of patient by a nurse practitioner after 3 days; and Group 3: Post-dated prescription forwarded to hospital pharmacy). Patients were contacted 10 days afterwards to ascertain wellbeing and actions taken, and patients were asked rate the service on a Likert scale. Post-study informal discussions were conducted with hospital staff. Results: In total, 142 patients met inclusion criteria. Groups 0, 1, 2 and 3 had 61, 16, 44 and 21 patients, respectively. Common diagnosis was sore throat (73%). Only one patient took antibiotics after 3 days. Nearly all (141/142) patients were successfully contacted on day 10, and of these, 102 (72%) rated their experiences as good or very good. Informal discussions with staff revealed improved knowledge of AMR. Conclusions: Delayed/back-up prescribing can reduce antibiotic consumption amongst outpatient department patients with suspected URTIs. Delayed/back-up prescribing can be implemented safely in low and middle-income countries (LMICs).
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Affiliation(s)
- Sam Ghebrehewet
- Public Health England North West Health Protection Team, Liverpool L3 1JR, UK;
| | - Wendi Shepherd
- Public Health England North West Health Protection Team, Liverpool L3 1JR, UK;
- Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK;
| | | | - Saran Shantikumar
- Warwick Medical School, University of Warwick, Coventry CV4 7HL, UK;
| | - Valerie Decraene
- Public Health England National Infection Service, Liverpool L3 1JR, UK;
| | | | - Menaal Kaushal
- LEKMA Hospital, Accra, Ghana; (M.K.); (A.A.); (D.A.); (G.A.)
| | - Afua Akuffo
- LEKMA Hospital, Accra, Ghana; (M.K.); (A.A.); (D.A.); (G.A.)
| | - Dinah Ayerh
- LEKMA Hospital, Accra, Ghana; (M.K.); (A.A.); (D.A.); (G.A.)
| | - George Amofah
- LEKMA Hospital, Accra, Ghana; (M.K.); (A.A.); (D.A.); (G.A.)
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11
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Sallis A, Bondaronek P, Sanders JG, Yu LM, Harris V, Vlaev I, Sanders M, Tonkin-Crine S, Chadborn T. Prescriber Commitment Posters to Increase Prudent Antibiotic Prescribing in English General Practice: A Cluster Randomized Controlled Trial. Antibiotics (Basel) 2020; 9:E490. [PMID: 32784625 PMCID: PMC7569839 DOI: 10.3390/antibiotics9080490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/25/2020] [Accepted: 07/01/2020] [Indexed: 01/21/2023] Open
Abstract
Unnecessary antibiotic prescribing contributes to Antimicrobial Resistance posing a major public health risk. Estimates suggest as many as half of antibiotics prescribed for respiratory infections may be unnecessary. We conducted a three-armed unblinded cluster randomized controlled trial (ISRCTN trial registry 83322985). Interventions were a commitment poster (CP) advocating safe antibiotic prescribing or a CP plus an antimicrobial stewardship message (AM) on telephone appointment booking lines, tested against a usual care control group. The primary outcome measure was antibiotic item dispensing rates per 1000 population adjusted for practice demographics. The outcome measures for post-hoc analysis were dispensing rates of antibiotics usually prescribed for upper respiratory tract infections and broad spectrum antibiotics. In total, 196 practice units were randomized to usual care (n = 60), CP (n = 66), and CP&AM (n = 70). There was no effect on the overall dispensing rates for either interventions compared to usual care (CP 5.673, 95%CI -9.768 to 21.113, p = 0.458; CP&AM, -12.575, 95%CI -30.726 to 5.576, p = 0.167). Secondary analysis, which included pooling the data into one model, showed a significant effect of the AM (-18.444, 95%CI -32.596 to -4.292, p = 0.012). Fewer penicillins and macrolides were prescribed in the CP&AM intervention compared to usual care (-12.996, 95% CI -34.585 to -4.913, p = 0.018). Commitment posters did not reduce antibiotic prescribing. An automated patient antimicrobial stewardship message showed effects and requires further testing.
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Affiliation(s)
- Anna Sallis
- Public Health England Behavioural Insights (PHEBI), Research, Translation & Innovation, Public Health England, Wellington House, 133-155 Waterloo Rd, Lambeth, London SE1 8UG, UK; (P.B.); (J.G.S.); (T.C.)
| | - Paulina Bondaronek
- Public Health England Behavioural Insights (PHEBI), Research, Translation & Innovation, Public Health England, Wellington House, 133-155 Waterloo Rd, Lambeth, London SE1 8UG, UK; (P.B.); (J.G.S.); (T.C.)
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, London SE1 8UG, UK
| | - Jet G. Sanders
- Public Health England Behavioural Insights (PHEBI), Research, Translation & Innovation, Public Health England, Wellington House, 133-155 Waterloo Rd, Lambeth, London SE1 8UG, UK; (P.B.); (J.G.S.); (T.C.)
- Department of Psychological and Behavioural Science, London School of Economics and Political Sciences, London SE1 8UG, UK
| | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences University of Oxford, Radcliffe Primary Care, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (L.-M.Y.); (V.H.); (S.T.-C.)
| | - Victoria Harris
- Nuffield Department of Primary Care Health Sciences University of Oxford, Radcliffe Primary Care, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (L.-M.Y.); (V.H.); (S.T.-C.)
| | - Ivo Vlaev
- Warwick Business School, University of Warwick, Coventry CV4 7AL, UK;
| | - Michael Sanders
- The Behavioural Insights Team. 4 Matthew Parker St, Westminster, London SW1H 9NP, UK;
| | - Sarah Tonkin-Crine
- Nuffield Department of Primary Care Health Sciences University of Oxford, Radcliffe Primary Care, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (L.-M.Y.); (V.H.); (S.T.-C.)
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford OX2 6GG, UK
| | - Tim Chadborn
- Public Health England Behavioural Insights (PHEBI), Research, Translation & Innovation, Public Health England, Wellington House, 133-155 Waterloo Rd, Lambeth, London SE1 8UG, UK; (P.B.); (J.G.S.); (T.C.)
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12
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Saliba-Gustafsson EA, Röing M, Borg MA, Rosales-Klintz S, Lundborg CS. General practitioners' perceptions of delayed antibiotic prescription for respiratory tract infections: A phenomenographic study. PLoS One 2019; 14:e0225506. [PMID: 31756197 PMCID: PMC6874332 DOI: 10.1371/journal.pone.0225506] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/06/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Antibiotic use is a major driver of antibiotic resistance. Although delayed antibiotic prescription is a recommended strategy to reduce antibiotic use, practices vary; it appears less commonly used in southern European countries where antibiotic consumption is highest. Despite these variations, few qualitative studies have explored general practitioners' perceptions of delayed antibiotic prescription. We therefore aimed to explore and describe the perceptions of delayed antibiotic prescription for respiratory tract infections among general practitioners in Malta. METHODS This qualitative phenomenographic study was conducted in Malta. A semi-structured interview guide was developed in English, pilot tested and revised accordingly. Interview topics included views on antibiotic resistance, antibiotic use and delayed antibiotic prescription for respiratory tract infections, and barriers and facilitators to antibiotic prescription. Individual, face-to-face interviews were held in 2014 with a quota sample of 20 general practitioners and transcribed verbatim. Data were subsequently analysed using a phenomenographic approach. FINDINGS General practitioners perceived delayed antibiotic prescription in five qualitatively different ways: (A) "The Service Provider"-maintaining a good general practitioner-patient relationship to retain patients and avoid doctor-shopping, (B) "The Uncertainty Avoider"-reaching a compromise and providing treatment just in case, (C) "The Comforter"-providing the patient comfort and reassurance, (D) "The Conscientious Practitioner"-empowering and educating patients, and limiting antibiotic use, and (E) "The Holder of Professional Power"-retaining general practitioner responsibility by employing a wait-and-see approach. Although general practitioners were largely positive towards delayed antibiotic prescription, not all supported the strategy; some preferred a wait-and-see approach with follow-up. Many delayed antibiotic prescription users selectively practiced delayed prescription with patients they trusted or who they believed had a certain level of knowledge and understanding. They also preferred a patient-led approach with a one to three day delay; post-dating delayed antibiotic prescriptions was uncommon. CONCLUSIONS In this study we have shown that general practitioners hold varying perceptions about delayed antibiotic prescription and that there is variation in the way delayed antibiotic prescription is employed in Malta. Whilst delayed antibiotic prescription is utilised in Malta, not all general practitioners support the strategy, and motivations and practices differ. In high consumption settings, formal and standardised implementation of delayed antibiotic prescription could help curb antibiotic overuse. Diagnosis-specific delayed antibiotic prescription recommendations should also be incorporated into guidelines. Finally, further investigation into patients' and pharmacists' views on delayed antibiotic prescription is required. TRIAL REGISTRATION NUMBER NCT03218930.
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Affiliation(s)
- Erika A. Saliba-Gustafsson
- Department of Global Public Health, Health Systems and Policy: Improving Use of Medicines, Karolinska Institutet, Stockholm, Sweden
| | - Marta Röing
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden
| | - Michael A. Borg
- Department of Infection Prevention and Control, Mater Dei Hospital, Msida, Malta
- Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Senia Rosales-Klintz
- Department of Global Public Health, Health Systems and Policy: Improving Use of Medicines, Karolinska Institutet, Stockholm, Sweden
- Unit of Surveillance and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Cecilia Stålsby Lundborg
- Department of Global Public Health, Health Systems and Policy: Improving Use of Medicines, Karolinska Institutet, Stockholm, Sweden
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13
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Ellis J, Vassilev I, Kennedy A, Moore M, Rogers A. Help seeking for antibiotics; is the influence of a personal social network relevant? BMC FAMILY PRACTICE 2019; 20:63. [PMID: 31088394 PMCID: PMC6518744 DOI: 10.1186/s12875-019-0955-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/30/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Health policy focuses on reducing antibiotic prescribing that in order to succeed requires the public to hold similar attitudes towards judicious use. Social network influences on health behaviour and attitudes are well established and yet these influences are not sufficiently acknowledged in the UK's antibiotic stewardship programmes. Therefore, the aim of this study was to evaluate individuals' attitudes and behaviours towards antibiotics and also identify the social network influences on these in the process of help seeking for self-limiting illnesses. METHODS From a social network approach the methods used were a personal community mapping exercise which was carried out ahead of a semi-structured interview. A purposive sample was drawn from across the Wessex region and participants were recruited via GP practices and pharmacists. In total 14 adults, and 10 parents of children, who had received a prescription for antibiotics for a self-limiting illness within the 3 months preceding the interview were recruited and interviewed. RESULTS Three network types were identified; diverse, family and friend and restricted. The type of network an individual has appears to have an influence on antibiotic attitudes and behaviours. Most notably, the more diverse a network the more likely the individual will delay in help seeking from healthcare professionals as they draw upon self-care strategies advised by network members. The role of the GP varies according to network type too. Individuals' with diverse networks draw upon GP network members to provide clarity and certainty following a period of self-care. People with restricted networks are more reliant upon the GP, seek help quicker and also more likely to prioritise the GPs advice over other sources of information. CONCLUSION The understanding a social network approach brings to help seeking behaviour for antibiotics could help practitioners modify their consultation approach to mitigate some uncertainties and perceptions around prescribing behaviour.
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Affiliation(s)
- J Ellis
- NIHR CLAHRC Wessex, School of Health Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK.
| | - I Vassilev
- NIHR CLAHRC Wessex, School of Health Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK
| | - A Kennedy
- NIHR CLAHRC Wessex, School of Health Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK
| | - M Moore
- NIHR CLAHRC Wessex, Primary Care and Population Science, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
| | - A Rogers
- NIHR CLAHRC Wessex, School of Health Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK
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14
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van Uum RT, Venekamp RP, Schilder AGM, Damoiseaux RAMJ, Anthierens S. Pain management in acute otitis media: a qualitative study of parents' views and expectations. BMC FAMILY PRACTICE 2019; 20:18. [PMID: 30674279 PMCID: PMC6343236 DOI: 10.1186/s12875-019-0908-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/15/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND For unclarified reasons, parents tend to be cautious about administering analgesics to their children, potentially leading to suboptimal management of AOM symptoms. We aim to understand parents' views and expectations of pain management in acute otitis media (AOM) in children. METHODS Qualitative study alongside a cluster-randomised controlled trial (PIM-POM study) aimed at optimising pain management in childhood AOM. We purposefully sampled 14 parents of children diagnosed with AOM by their GP, who were recruited to the trial between November 2017 and May 2018. Semi-structured interviews were held at home in the first two weeks after trial enrollment. Interviews were audio-recorded, transcribed and analyzed thematically. RESULTS Parents experienced difficulties in recognising earache and other symptoms of an ear infection. They consulted the GP for a diagnosis, for reassurance and for management advice. Parents shared that, prior to consultation, they had insufficient knowledge of the benefits of correctly dosed pain medication at regularly scheduled intervals. Parents valued the GP's advice on pain management, and were happy to accept pain medication as standalone therapy, provided that the GP explained why antibiotics would not be needed. Parents' views and expectations of pain management in AOM were shaped by previous experiences of AOM within their family; those with a positive experience of pain medication are more likely to use it in subsequent AOM episodes. CONCLUSIONS Parents of children with AOM consult the GP to help cope with uncertainties in recognising symptoms of AOM, and to receive management advice. It is important that GPs are aware of parents' lack of understanding of the role of pain medication in managing AOM, and that they address this during the consultation. TRIAL REGISTRATION Netherlands Trial Register, identifier NTR4920 (registration date: 19 December 2014).
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Affiliation(s)
- Rick T. van Uum
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Office number FAC 5.09, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Roderick P. Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Office number FAC 5.09, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Anne G. M. Schilder
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Office number FAC 5.09, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
- evidENT, Ear Institute, University College London, London, UK
| | - Roger A. M. J. Damoiseaux
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Office number FAC 5.09, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Sibyl Anthierens
- Department of Primary Care and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
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15
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O'Connor R, O'Doherty J, O'Regan A, Dunne C. Antibiotic use for acute respiratory tract infections (ARTI) in primary care; what factors affect prescribing and why is it important? A narrative review. Ir J Med Sci 2018; 187:969-986. [PMID: 29532292 PMCID: PMC6209023 DOI: 10.1007/s11845-018-1774-5] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 02/23/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Antimicrobial resistance is an emerging global threat to health and is associated with increased consumption of antibiotics. Seventy-four per cent of antibiotic prescribing takes place in primary care. Much of this is for inappropriate treatment of acute respiratory tract infections. AIMS To review the published literature pertaining to antibiotic prescribing in order to identify and understand the factors that affect primary care providers' prescribing decisions. METHODS Six online databases were searched for relevant paper using agreed criteria. One hundred ninety-five papers were retrieved, and 139 were included in this review. RESULTS Primary care providers are highly influenced to prescribe by patient expectation for antibiotics, clinical uncertainty and workload induced time pressures. Strategies proven to reduce such inappropriate prescribing include appropriately aimed multifaceted educational interventions for primary care providers, mass media educational campaigns aimed at healthcare professionals and the public, use of good communication skills in the consultation, use of delayed prescriptions especially when accompanied by written information, point of care testing and, probably, longer less pressurised consultations. Delayed prescriptions also facilitate focused personalised patient education. CONCLUSION There is an emerging consensus in the literature regarding strategies proven to reduce antibiotic consumption for acute respiratory tract infections. The widespread adoption of these strategies in primary care is imperative.
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Affiliation(s)
- Ray O'Connor
- Graduate Entry Medical School, University of Limerick, Limerick City, Limerick, 000, Ireland.
| | - Jane O'Doherty
- Graduate Entry Medical School, University of Limerick, Limerick City, Limerick, 000, Ireland
| | - Andrew O'Regan
- Graduate Entry Medical School, University of Limerick, Limerick City, Limerick, 000, Ireland
| | - Colum Dunne
- Graduate Entry Medical School, University of Limerick, Limerick City, Limerick, 000, Ireland
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