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Primary care clinicians' perceptions of antibiotic resistance: a multi-country qualitative interview study

Primary care clinicians' perceptions of antibiotic resistance: a multi-country qualitative interview study
Primary care clinicians' perceptions of antibiotic resistance: a multi-country qualitative interview study
OBJECTIVES: To explore and compare primary care clinicians' perceptions of antibiotic resistance in relation to the management of community-acquired lower respiratory tract infection (LRTI) in contrasting European settings.

METHODS: Qualitative interview study with 80 primary care clinicians in nine European countries. Data were subjected to a five-stage analytical framework approach (familiarization; developing a thematic framework from the interview questions and the themes emerging from the data; indexing; charting; and mapping to search for interpretations in the data). Preliminary analysis reports were sent to all network facilitators for validation.

RESULTS: Most clinicians stated that antibiotic resistance was not a problem in their practice. Some recommended enhanced feedback about local resistance rates. Northern European respondents generally favoured using the narrowest-spectrum agent, motivated by containing resistance, whereas southern/eastern European respondents were more motivated by maximizing the potential of a rapid treatment effect and so justified empirical use of broad-spectrum antibiotics. Antibiotic treatment failure was ascribed largely to viral aetiology rather than resistant bacteria. Clinicians generally agreed that resistance will become more serious without enhanced antibiotic stewardship or new drug discovery.

CONCLUSIONS: If current rates of antibiotic resistance are likely to result in important treatment failures, then provision of local resistance data is likely to enhance clinicians' sense of importance of the issue. Interventions to enhance the quality of antibiotic prescribing in primary care should address perceptions, particularly in the south and east of Europe, that possible advantages to patients from antibiotic treatment in general, and from newer broad-spectrum compared with narrow-spectrum agents, outweigh disadvantages to patients and society from associated effects on antibiotic resistance.
0305-7453
237-243
Wood, F.
4ed6fab7-a422-4029-86a1-b84e8ca377f6
Phillips, C.
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Brookes-Howell, L.
14625445-131f-4864-8033-3868153839ad
Hood, K.
12e14eb3-2c75-409f-a69d-add733644d89
Verheij, T.
cc355b92-ba85-4102-98a0-cee55f0504f6
Coenen, S.
9afe2a52-9f4f-45bb-b8e5-c6ee3eeb3498
Little, P.
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Melbye, H.
0af8f977-61f5-414a-82ba-8843eb63df77
Godycki-Cwirko, M.
49c96dba-8729-4f32-8ee9-fb43f1285b8f
Jakobsen, K.
03eaa2b3-18aa-4633-b71e-9711c358ac2a
Worby, P.
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Goossens, H.
533640f7-b568-4d95-a7c1-28158d154ba8
Butler, C.C.
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Wood, F.
4ed6fab7-a422-4029-86a1-b84e8ca377f6
Phillips, C.
29b081da-ebfc-428c-8238-0935952d3a0c
Brookes-Howell, L.
14625445-131f-4864-8033-3868153839ad
Hood, K.
12e14eb3-2c75-409f-a69d-add733644d89
Verheij, T.
cc355b92-ba85-4102-98a0-cee55f0504f6
Coenen, S.
9afe2a52-9f4f-45bb-b8e5-c6ee3eeb3498
Little, P.
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Melbye, H.
0af8f977-61f5-414a-82ba-8843eb63df77
Godycki-Cwirko, M.
49c96dba-8729-4f32-8ee9-fb43f1285b8f
Jakobsen, K.
03eaa2b3-18aa-4633-b71e-9711c358ac2a
Worby, P.
297204c2-8f33-4bd1-a866-75247eae6932
Goossens, H.
533640f7-b568-4d95-a7c1-28158d154ba8
Butler, C.C.
736f78ad-3e18-4c63-900f-c2249577b645

Wood, F., Phillips, C., Brookes-Howell, L., Hood, K., Verheij, T., Coenen, S., Little, P., Melbye, H., Godycki-Cwirko, M., Jakobsen, K., Worby, P., Goossens, H. and Butler, C.C. (2013) Primary care clinicians' perceptions of antibiotic resistance: a multi-country qualitative interview study. Journal of Antimicrobial Chemotherapy, 68 (1), 237-243. (doi:10.1093/jac/dks338). (PMID:22949622)

Record type: Article

Abstract

OBJECTIVES: To explore and compare primary care clinicians' perceptions of antibiotic resistance in relation to the management of community-acquired lower respiratory tract infection (LRTI) in contrasting European settings.

METHODS: Qualitative interview study with 80 primary care clinicians in nine European countries. Data were subjected to a five-stage analytical framework approach (familiarization; developing a thematic framework from the interview questions and the themes emerging from the data; indexing; charting; and mapping to search for interpretations in the data). Preliminary analysis reports were sent to all network facilitators for validation.

RESULTS: Most clinicians stated that antibiotic resistance was not a problem in their practice. Some recommended enhanced feedback about local resistance rates. Northern European respondents generally favoured using the narrowest-spectrum agent, motivated by containing resistance, whereas southern/eastern European respondents were more motivated by maximizing the potential of a rapid treatment effect and so justified empirical use of broad-spectrum antibiotics. Antibiotic treatment failure was ascribed largely to viral aetiology rather than resistant bacteria. Clinicians generally agreed that resistance will become more serious without enhanced antibiotic stewardship or new drug discovery.

CONCLUSIONS: If current rates of antibiotic resistance are likely to result in important treatment failures, then provision of local resistance data is likely to enhance clinicians' sense of importance of the issue. Interventions to enhance the quality of antibiotic prescribing in primary care should address perceptions, particularly in the south and east of Europe, that possible advantages to patients from antibiotic treatment in general, and from newer broad-spectrum compared with narrow-spectrum agents, outweigh disadvantages to patients and society from associated effects on antibiotic resistance.

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e-pub ahead of print date: 4 September 2012
Published date: January 2013
Organisations: Primary Care & Population Sciences

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Local EPrints ID: 350034
URI: https://eprints.soton.ac.uk/id/eprint/350034
ISSN: 0305-7453
PURE UUID: 64b1e2d1-9ebc-4ff4-9e71-e16adfbfe530

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Date deposited: 15 Mar 2013 12:08
Last modified: 16 Jul 2019 21:40

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Contributors

Author: F. Wood
Author: C. Phillips
Author: L. Brookes-Howell
Author: K. Hood
Author: T. Verheij
Author: S. Coenen
Author: P. Little
Author: H. Melbye
Author: M. Godycki-Cwirko
Author: K. Jakobsen
Author: P. Worby
Author: H. Goossens
Author: C.C. Butler

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