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Understanding variation in primary medical care: a nine-country qualitative study of clinicians' accounts of the non-clinical factors that shape antibiotic prescribing decisions for lower respiratory tract infection

Understanding variation in primary medical care: a nine-country qualitative study of clinicians' accounts of the non-clinical factors that shape antibiotic prescribing decisions for lower respiratory tract infection
Understanding variation in primary medical care: a nine-country qualitative study of clinicians' accounts of the non-clinical factors that shape antibiotic prescribing decisions for lower respiratory tract infection
Objectives: there is a wide variation between European countries in antibiotic prescribing for patients in primary care with lower respiratory tract infection (LRTI) that is not explained by case mix and clinical factors alone. Variation in antibiotic prescribing that is not warranted by differences in illness and clinical presentation may increase selection of resistant organisms, contributing to the problem of antibiotic resistance. This study aimed to investigate clinicians’ accounts of non-clinical factors that influence their antibiotic prescribing decision for patients with LRTI, to understand variation and identify opportunities for addressing possible unhelpful variation.

Design: multicountry qualitative semistructured interview study, with data subjected to a five-stage analytic framework approach (familiarisation, developing a thematic framework from interview questions and emerging themes, indexing, charting and interpretation), and with interviewers commenting on preliminary analytic themes.

Setting: primary care.

Participants: eighty primary care clinicians randomly selected from primary care research networks based in nine European cities.

Results: clinicians’ accounts identified non-clinical factors imposed by the healthcare system operating within specific regional primary care research networks, including patient access to antibiotics before consulting a doctor (Barcelona and Milan), systems to reduce patient expectations for antibiotics (Southampton and Antwerp) and lack of consistent treatment guidelines (Balatonfüred and ?ód?). Secondly, accounts revealed factors related to specific characteristics of clinicians regardless of network (professional ethos, self-belief in decision-making and commitment to shared decision-making).

Conclusions: addressing healthcare system factors (eg, limiting patients’ self-management with antibiotics before consulting in primary care, increased public awareness and provision of more consistent guidelines) may assist in reducing unhelpful variation in antibiotic prescribing. Promoting clinicians’ receptivity to change, confidence in decision-making and readiness to invest in explaining prescribing decisions may also be beneficial. As factors were emphasised differently between networks, local flexibility in interventions is likely to maximise effectiveness
e000796
Brookes-Howell, Lucy
307c5275-082d-4586-ba9d-461527607164
Hood, Kerenza
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Cooper, Lucy
bf92ca8d-1759-49a1-82b4-697599450d2a
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Verheij, Theo
772e019f-486f-4a64-9260-bac6446a85d2
Coenen, Samuel
3d0dc4e0-e5ba-4d66-ba92-15900ccc551e
Godycki-Cwirko, Maciek
306b5836-4955-470d-bf1f-77c6ac282138
Melbye, Hasse
be60ca95-b236-48e5-8eb9-c9a153d54a8f
Borras-Santos, Alicia
88855642-7a83-417c-abcf-a4527931b06d
Worby, Patricia
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Jakobsen, Kristin
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Goossens, Herman
31f8e1ae-7da0-473c-bd49-f911c2187451
Butler, Christopher C.
2782a915-eb8d-48bb-ae70-118114697f57
Brookes-Howell, Lucy
307c5275-082d-4586-ba9d-461527607164
Hood, Kerenza
62906d76-4931-4b12-9a64-0c867c7b84c1
Cooper, Lucy
bf92ca8d-1759-49a1-82b4-697599450d2a
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Verheij, Theo
772e019f-486f-4a64-9260-bac6446a85d2
Coenen, Samuel
3d0dc4e0-e5ba-4d66-ba92-15900ccc551e
Godycki-Cwirko, Maciek
306b5836-4955-470d-bf1f-77c6ac282138
Melbye, Hasse
be60ca95-b236-48e5-8eb9-c9a153d54a8f
Borras-Santos, Alicia
88855642-7a83-417c-abcf-a4527931b06d
Worby, Patricia
6f0398a6-5871-4519-905c-0f08b02a03be
Jakobsen, Kristin
7a6cd8fe-c352-42de-87ca-0e390f8266d0
Goossens, Herman
31f8e1ae-7da0-473c-bd49-f911c2187451
Butler, Christopher C.
2782a915-eb8d-48bb-ae70-118114697f57

Brookes-Howell, Lucy, Hood, Kerenza, Cooper, Lucy, Little, Paul, Verheij, Theo, Coenen, Samuel, Godycki-Cwirko, Maciek, Melbye, Hasse, Borras-Santos, Alicia, Worby, Patricia, Jakobsen, Kristin, Goossens, Herman and Butler, Christopher C. (2012) Understanding variation in primary medical care: a nine-country qualitative study of clinicians' accounts of the non-clinical factors that shape antibiotic prescribing decisions for lower respiratory tract infection. BMJ Open, 2 (4), e000796. (doi:10.1136/bmjopen-2011-000796). (PMID:22918670)

Record type: Article

Abstract

Objectives: there is a wide variation between European countries in antibiotic prescribing for patients in primary care with lower respiratory tract infection (LRTI) that is not explained by case mix and clinical factors alone. Variation in antibiotic prescribing that is not warranted by differences in illness and clinical presentation may increase selection of resistant organisms, contributing to the problem of antibiotic resistance. This study aimed to investigate clinicians’ accounts of non-clinical factors that influence their antibiotic prescribing decision for patients with LRTI, to understand variation and identify opportunities for addressing possible unhelpful variation.

Design: multicountry qualitative semistructured interview study, with data subjected to a five-stage analytic framework approach (familiarisation, developing a thematic framework from interview questions and emerging themes, indexing, charting and interpretation), and with interviewers commenting on preliminary analytic themes.

Setting: primary care.

Participants: eighty primary care clinicians randomly selected from primary care research networks based in nine European cities.

Results: clinicians’ accounts identified non-clinical factors imposed by the healthcare system operating within specific regional primary care research networks, including patient access to antibiotics before consulting a doctor (Barcelona and Milan), systems to reduce patient expectations for antibiotics (Southampton and Antwerp) and lack of consistent treatment guidelines (Balatonfüred and ?ód?). Secondly, accounts revealed factors related to specific characteristics of clinicians regardless of network (professional ethos, self-belief in decision-making and commitment to shared decision-making).

Conclusions: addressing healthcare system factors (eg, limiting patients’ self-management with antibiotics before consulting in primary care, increased public awareness and provision of more consistent guidelines) may assist in reducing unhelpful variation in antibiotic prescribing. Promoting clinicians’ receptivity to change, confidence in decision-making and readiness to invest in explaining prescribing decisions may also be beneficial. As factors were emphasised differently between networks, local flexibility in interventions is likely to maximise effectiveness

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Published date: August 2012
Organisations: Primary Care & Population Sciences

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Local EPrints ID: 349991
URI: https://eprints.soton.ac.uk/id/eprint/349991
PURE UUID: 56ba96c8-1230-4c94-ad19-708f0ecca8b3

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Date deposited: 15 Mar 2013 10:12
Last modified: 16 Jul 2019 21:41

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Contributors

Author: Lucy Brookes-Howell
Author: Kerenza Hood
Author: Lucy Cooper
Author: Paul Little
Author: Theo Verheij
Author: Samuel Coenen
Author: Maciek Godycki-Cwirko
Author: Hasse Melbye
Author: Alicia Borras-Santos
Author: Patricia Worby
Author: Kristin Jakobsen
Author: Herman Goossens
Author: Christopher C. Butler

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