Changing the prescribing behaviour of general practitioners: understanding the acceptability and feasibility of interventions to promote prudent antibiotic use across Europe

Abstract

Antibiotic resistance is recognised as an international health concern due to its potential to increase morbidity and mortality from illnesses that are currently treatable. Antibiotic prescribing by GPs in primary care has been shown to directly contribute to rates of antibiotic resistance. Many interventions have been introduced across European countries in an attempt to promote prudent use of antibiotics for respiratory tract infections in primary care. Exploring GPs' views and experiences of interventions to promote prudent antibiotic use can help to understand what is viewed as acceptable by GPs and what may encourage behaviour change. In addition, investigating these views across countries can highlight any similarities and differences between contexts and examine whether interventions which are acceptable, feasible and potentially effective in one context may be appropriate for implementation in others.

The main aim of this research was to explore GPs' and experts' views and experiences of antibiotic prescribing and interventions to promote prudent antibiotic use in the management of RTIs. If professionals hold different views there is a need to develop interventions for each country, whereas if professionals hold similar views then an intervention which is acceptable in one country can be implemented in others.

Two qualitative studies were carried out to explore GPs' and experts' views of antibiotic prescribing and interventions to promote prudent use across five European countries. The results of both studies revealed consistent views despite differences in context, indicating that both GPs and experts who develop interventions held similar beliefs about the acceptability and feasibility of different types of interventions.

Secondly, a systematic review was undertaken which synthesised all qualitative work which had explored GPs' views on antibiotic prescribing or interventions to promote prudent use. The review incorporated studies from several countries and produced a model highlighting seven factors which influence GPs' prescribing decisions and aspects of interventions which could address these factors.

The findings of this thesis reveal the barriers experienced by GPs in prudent antibiotic prescribing and suggest that it is suitable to develop an intervention to promote prudent antibiotic use for implementation at an international level.

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ORCID for Lucy Yardley: orcid.org/0000-0002-3853-883X

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