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Understanding the delayed prescribing of antibiotics for respiratory tract infection in primary care: a qualitative analysis

Understanding the delayed prescribing of antibiotics for respiratory tract infection in primary care: a qualitative analysis
Understanding the delayed prescribing of antibiotics for respiratory tract infection in primary care: a qualitative analysis
OBJECTIVE: To identify general practitioner (GP) views and understanding on the use of delayed prescribing in primary care.

DESIGN: Qualitative semistructured telephone interview study.

SETTING: Primary care general practices in England.

PARTICIPANTS: 32 GPs from identified high-prescribing and low-prescribing general practices in England.

METHOD: Semistructured telephone interviews were conducted with GPs identified from practices within clinical commissioning groups with the highest and lowest prescribing rates in England. A thematic analysis of the data was conducted to generate themes.

RESULTS: All GPs had a good understanding of respiratory tract infection (RTI) management and how the delayed prescribing approach could be used in primary care. However, GPs highlighted factors that were influential as to whether delayed prescribing was successfully carried out during the consultation. These included the increase in evidence of antimicrobial resistance, and GPs' prior experiences of using delayed prescribing during the consultation. The patient-practitioner relationship could also influence treatment outcomes for RTI, and a lack of an agreed prescribing strategy within and between practices was considered to be of significance to GPs. Participants expressed that a lack of feedback on prescribing data at an individual and practice level made it difficult to know if delayed prescribing strategies were successful in reducing unnecessary consumption. GPs agreed that coherent and uniform training and guidelines would be of some benefit to ensure consistent prescribing throughout the UK.

CONCLUSIONS: Delayed prescribing is encouraged in primary care, but is not always implemented successfully. Greater uniformity within and between practices in the UK is needed to operationalise delayed prescribing, as well as providing feedback on the uptake of antibiotics. Finally, GPs may need further guidance on how to answer the concerns of patients without interpreting these questions as a demand for antibiotics, as well as educating the patient about antimicrobial resistance and supporting a good patient-practitioner relationship.
general practice, family practice, qualitative research, infectious diseases
1-12
Ryves, Rachel
d592b6a9-017b-4470-9ebd-b6ec272b7213
Eyles, Caroline
f8518cbb-669f-4cf6-bacb-4a174e385483
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
McDermott, Lisa
10aa4fe3-7260-4080-8f8b-7c14b3ca409e
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Leydon, Gerry
c5cdaff5-0fa1-4d38-b575-b97c2892ec40
Ryves, Rachel
d592b6a9-017b-4470-9ebd-b6ec272b7213
Eyles, Caroline
f8518cbb-669f-4cf6-bacb-4a174e385483
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
McDermott, Lisa
10aa4fe3-7260-4080-8f8b-7c14b3ca409e
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Leydon, Gerry
c5cdaff5-0fa1-4d38-b575-b97c2892ec40

Ryves, Rachel, Eyles, Caroline, Moore, Michael, McDermott, Lisa, Little, Paul and Leydon, Gerry (2016) Understanding the delayed prescribing of antibiotics for respiratory tract infection in primary care: a qualitative analysis. BMJ Open, 6 (e011882), 1-12. (doi:10.1136/bmjopen-2016-011882). (PMID:27864242)

Record type: Article

Abstract

OBJECTIVE: To identify general practitioner (GP) views and understanding on the use of delayed prescribing in primary care.

DESIGN: Qualitative semistructured telephone interview study.

SETTING: Primary care general practices in England.

PARTICIPANTS: 32 GPs from identified high-prescribing and low-prescribing general practices in England.

METHOD: Semistructured telephone interviews were conducted with GPs identified from practices within clinical commissioning groups with the highest and lowest prescribing rates in England. A thematic analysis of the data was conducted to generate themes.

RESULTS: All GPs had a good understanding of respiratory tract infection (RTI) management and how the delayed prescribing approach could be used in primary care. However, GPs highlighted factors that were influential as to whether delayed prescribing was successfully carried out during the consultation. These included the increase in evidence of antimicrobial resistance, and GPs' prior experiences of using delayed prescribing during the consultation. The patient-practitioner relationship could also influence treatment outcomes for RTI, and a lack of an agreed prescribing strategy within and between practices was considered to be of significance to GPs. Participants expressed that a lack of feedback on prescribing data at an individual and practice level made it difficult to know if delayed prescribing strategies were successful in reducing unnecessary consumption. GPs agreed that coherent and uniform training and guidelines would be of some benefit to ensure consistent prescribing throughout the UK.

CONCLUSIONS: Delayed prescribing is encouraged in primary care, but is not always implemented successfully. Greater uniformity within and between practices in the UK is needed to operationalise delayed prescribing, as well as providing feedback on the uptake of antibiotics. Finally, GPs may need further guidance on how to answer the concerns of patients without interpreting these questions as a demand for antibiotics, as well as educating the patient about antimicrobial resistance and supporting a good patient-practitioner relationship.

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More information

Submitted date: 11 March 2016
Accepted/In Press date: 16 August 2016
e-pub ahead of print date: 18 November 2016
Published date: November 2016
Keywords: general practice, family practice, qualitative research, infectious diseases
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 403209
URI: https://eprints.soton.ac.uk/id/eprint/403209
PURE UUID: 9f2374c7-a08e-4de0-acc0-ece7b0827bfd
ORCID for Rachel Ryves: ORCID iD orcid.org/0000-0002-3757-1152
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for Gerry Leydon: ORCID iD orcid.org/0000-0001-5986-3300

Catalogue record

Date deposited: 28 Nov 2016 14:36
Last modified: 17 Jul 2019 00:53

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