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Clinical influences on antibiotic prescribing decisions for lower respiratory tract infection: a nine country qualitative study of variation in care

Clinical influences on antibiotic prescribing decisions for lower respiratory tract infection: a nine country qualitative study of variation in care
Clinical influences on antibiotic prescribing decisions for lower respiratory tract infection: a nine country qualitative study of variation in care
Objectives: there is variation in antibiotic prescribing for lower respiratory tract infections (LRTI) in primary care that does not benefit patients. This study aims to investigate clinicians' accounts of clinical influences on antibiotic prescribing decisions for LRTI to better understand variation and identify opportunities for improvement.

Design: multi country qualitative interview study. Semi-structured interviews using open-ended questions and a patient scenario. Data were subjected to five-stage analytic framework approach (familiarisation, developing a thematic framework from the interview questions and emerging themes, indexing, charting and mapping to search for interpretations), with interviewers commenting on preliminary reports.

Setting: primary care.

Participants: 80 primary care clinicians randomly selected from primary care research networks based in nine European cities.

Results: clinicians reported four main individual clinical factors that guided their antibiotic prescribing decision: auscultation, fever, discoloured sputum and breathlessness. These were considered alongside a general impression of the patient derived from building a picture of the illness course, using intuition and familiarity with the patient. Comorbidity and older age were considered main risk factors for poor outcomes. Clinical factors were similar across networks, apart from C reactive protein near patient testing in Tromsø. Clinicians developed ways to handle diagnostic and management uncertainty through their own clinical routines.

Conclusions: clinicians emphasised the importance of auscultation, fever, discoloured sputum and breathlessness, general impression of the illness course, familiarity with the patient, comorbidity, and age in informing their antibiotic prescribing decisions for LRTI. As some of these factors may be overemphasised given the evolving evidence base, greater standardisation of assessment and integration of findings may help reduce unhelpful variation in management. Non-clinical influences will also need to be addressed
e000795
Brookes-Howell, Lucy
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Hood, Kerenza
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Cooper, Lucy
bf92ca8d-1759-49a1-82b4-697599450d2a
Coenen, Samuel
3d0dc4e0-e5ba-4d66-ba92-15900ccc551e
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Verheij, Theo
772e019f-486f-4a64-9260-bac6446a85d2
Godycki-Cwirko, Maciek
306b5836-4955-470d-bf1f-77c6ac282138
Melbye, Hasse
be60ca95-b236-48e5-8eb9-c9a153d54a8f
Krawczyk, Jaroslaw
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Borras-Santos, Aalicia
b858c0e0-b08a-4670-9700-feeff999d4c8
Jakobsen, Kristin
7a6cd8fe-c352-42de-87ca-0e390f8266d0
Worby, Patricia
6f0398a6-5871-4519-905c-0f08b02a03be
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
Coenen, Samuel
3d0dc4e0-e5ba-4d66-ba92-15900ccc551e
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Verheij, Theo
772e019f-486f-4a64-9260-bac6446a85d2
Godycki-Cwirko, Maciek
306b5836-4955-470d-bf1f-77c6ac282138
Melbye, Hasse
be60ca95-b236-48e5-8eb9-c9a153d54a8f
Krawczyk, Jaroslaw
9cd71906-85f1-4041-a2b2-0c3a513fb8e1
Borras-Santos, Aalicia
b858c0e0-b08a-4670-9700-feeff999d4c8
Jakobsen, Kristin
7a6cd8fe-c352-42de-87ca-0e390f8266d0
Worby, Patricia
6f0398a6-5871-4519-905c-0f08b02a03be
Goossens, Herman
31f8e1ae-7da0-473c-bd49-f911c2187451
Butler, Christopher C.
2782a915-eb8d-48bb-ae70-118114697f57

Brookes-Howell, Lucy, Hood, Kerenza, Cooper, Lucy, Coenen, Samuel, Little, Paul, Verheij, Theo, Godycki-Cwirko, Maciek, Melbye, Hasse, Krawczyk, Jaroslaw, Borras-Santos, Aalicia, Jakobsen, Kristin, Worby, Patricia, Goossens, Herman and Butler, Christopher C. (2012) Clinical influences on antibiotic prescribing decisions for lower respiratory tract infection: a nine country qualitative study of variation in care. BMJ Open, 2 (3), e000795. (doi:10.1136/bmjopen-2011-000795). (PMID:22619265)

Record type: Article

Abstract

Objectives: there is variation in antibiotic prescribing for lower respiratory tract infections (LRTI) in primary care that does not benefit patients. This study aims to investigate clinicians' accounts of clinical influences on antibiotic prescribing decisions for LRTI to better understand variation and identify opportunities for improvement.

Design: multi country qualitative interview study. Semi-structured interviews using open-ended questions and a patient scenario. Data were subjected to five-stage analytic framework approach (familiarisation, developing a thematic framework from the interview questions and emerging themes, indexing, charting and mapping to search for interpretations), with interviewers commenting on preliminary reports.

Setting: primary care.

Participants: 80 primary care clinicians randomly selected from primary care research networks based in nine European cities.

Results: clinicians reported four main individual clinical factors that guided their antibiotic prescribing decision: auscultation, fever, discoloured sputum and breathlessness. These were considered alongside a general impression of the patient derived from building a picture of the illness course, using intuition and familiarity with the patient. Comorbidity and older age were considered main risk factors for poor outcomes. Clinical factors were similar across networks, apart from C reactive protein near patient testing in Tromsø. Clinicians developed ways to handle diagnostic and management uncertainty through their own clinical routines.

Conclusions: clinicians emphasised the importance of auscultation, fever, discoloured sputum and breathlessness, general impression of the illness course, familiarity with the patient, comorbidity, and age in informing their antibiotic prescribing decisions for LRTI. As some of these factors may be overemphasised given the evolving evidence base, greater standardisation of assessment and integration of findings may help reduce unhelpful variation in management. Non-clinical influences will also need to be addressed

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

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Local EPrints ID: 349998
URI: https://eprints.soton.ac.uk/id/eprint/349998
PURE UUID: 89b91994-0aae-40a6-88c1-265ba1c7e5ff

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Date deposited: 15 Mar 2013 11:20
Last modified: 18 Jul 2017 04:38

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Contributors

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

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