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General practitioners’ perceptions of delayed antibiotic prescription for respiratory tract infections: A phenomenographic study


Autoři: Erika A. Saliba-Gustafsson aff001;  Marta Röing aff002;  Michael A. Borg aff003;  Senia Rosales-Klintz aff001;  Cecilia Stålsby Lundborg aff001
Působiště autorů: Department of Global Public Health, Health Systems and Policy: Improving Use of Medicines, Karolinska Institutet, Stockholm, Sweden aff001;  Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden aff002;  Department of Infection Prevention and Control, Mater Dei Hospital, Msida, Malta aff003;  Faculty of Medicine and Surgery, University of Malta, Msida, Malta aff004;  Unit of Surveillance and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden aff005
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0225506

Souhrn

Background

Antibiotic use is a major driver of antibiotic resistance. Although delayed antibiotic prescription is a recommended strategy to reduce antibiotic use, practices vary; it appears less commonly used in southern European countries where antibiotic consumption is highest. Despite these variations, few qualitative studies have explored general practitioners’ perceptions of delayed antibiotic prescription. We therefore aimed to explore and describe the perceptions of delayed antibiotic prescription for respiratory tract infections among general practitioners in Malta.

Methods

This qualitative phenomenographic study was conducted in Malta. A semi-structured interview guide was developed in English, pilot tested and revised accordingly. Interview topics included views on antibiotic resistance, antibiotic use and delayed antibiotic prescription for respiratory tract infections, and barriers and facilitators to antibiotic prescription. Individual, face-to-face interviews were held in 2014 with a quota sample of 20 general practitioners and transcribed verbatim. Data were subsequently analysed using a phenomenographic approach.

Findings

General practitioners perceived delayed antibiotic prescription in five qualitatively different ways: (A) “The Service Provider”–maintaining a good general practitioner-patient relationship to retain patients and avoid doctor-shopping, (B) “The Uncertainty Avoider”–reaching a compromise and providing treatment just in case, (C) “The Comforter”–providing the patient comfort and reassurance, (D) “The Conscientious Practitioner”–empowering and educating patients, and limiting antibiotic use, and (E) “The Holder of Professional Power”–retaining general practitioner responsibility by employing a wait-and-see approach. Although general practitioners were largely positive towards delayed antibiotic prescription, not all supported the strategy; some preferred a wait-and-see approach with follow-up. Many delayed antibiotic prescription users selectively practiced delayed prescription with patients they trusted or who they believed had a certain level of knowledge and understanding. They also preferred a patient-led approach with a one to three day delay; post-dating delayed antibiotic prescriptions was uncommon.

Conclusions

In this study we have shown that general practitioners hold varying perceptions about delayed antibiotic prescription and that there is variation in the way delayed antibiotic prescription is employed in Malta. Whilst delayed antibiotic prescription is utilised in Malta, not all general practitioners support the strategy, and motivations and practices differ. In high consumption settings, formal and standardised implementation of delayed antibiotic prescription could help curb antibiotic overuse. Diagnosis-specific delayed antibiotic prescription recommendations should also be incorporated into guidelines. Finally, further investigation into patients’ and pharmacists’ views on delayed antibiotic prescription is required.

Trial registration number

NCT03218930

Klíčová slova:

Antibiotic resistance – Antibiotics – Europe – General practitioners – Health education and awareness – Patients – Pharmacists – Qualitative studies


Zdroje

1. Cassini A, Högberg LD, Plachouras D, Quattrocchi A, Hoxha A, Simonsen GS, et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect Dis. 2019 Jan;19(1):56–66. doi: 10.1016/S1473-3099(18)30605-4 30409683

2. European Centre for Disease Prevention and Control. The bacterial challenge: time to react. A call to narrow the gap betwen multidrug-resistant bacteria in the EU and the development of new antibacterial agents. Stockholm, Sweden: ECDC; 2009.

3. European Commission. A European one health action plan against antimicrobial resistance (AMR). Brussels, Belgium: European Commission; 2017.

4. World Health Organization. Global action plan on antimicrobial resistance. Geneva, Switzerland: WHO; 2015.

5. Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ. 2010 May 18;340:c2096. doi: 10.1136/bmj.c2096 20483949

6. Goossens H, Ferech M, Vander Stichele R, Elseviers M, ESAC Project Group. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005 Feb 12–18;365(9459):579–87 15708101

7. Gulliford MC, Moore MV, Little P, Hay AD, Fox R, Prevost AT, et al. Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records. BMJ. 2016 Jul 4;354:i3410. doi: 10.1136/bmj.i3410 27378578

8. Sharland M, Kendall H, Yeates D, Randall A, Hughes G, Glasziou P, et al. Antibiotic prescribing in general practice and hospital admissions for peritonsillar abscess, mastoiditis, and rheumatic fever in children: time trend analysis. BMJ. 2005;331:328–9. doi: 10.1136/bmj.38503.706887.AE1 15967760

9. Dyar OJ, Beović B, Vlahović-Palčevski V, Verheij T, Pulcini C, on behalf of ESGAP (the ESCMID [European Society of Clinical Microbiology and Infectious Diseases] Study Group for Antibiotic Policies). How can we improve antibiotic prescribing in primary care? Expert Rev Anti Infect Ther. 2016;14(4):403–13. doi: 10.1586/14787210.2016.1151353 26853235

10. de la Poza Abad M, Mas Dalmau G, Moreno Bakedano M, González González AI, Canellas Criado Y, Hernández Anadón S, et al. Prescription strategies in acute uncomplicated respiratory infections: a randomized clinical trial. JAMA Intern Med. 2016 Jan;176(1):21–9. doi: 10.1001/jamainternmed.2015.7088 26719947

11. Little P, Moore M, Kelly J, Williamson I, Leydon G, McDermott L, et al. Delayed antibiotic prescribing strategies for respiratory tract infections in primary care: pragmatic, factorial, randomised controlled trial. BMJ. 2014;348:g1606. doi: 10.1136/bmj.g1606 24603565

12. Little P, Rumsby K, Kelly J, Watson L, Moore M, Warner G, et al. Information leaflet and antibiotic prescribing strategies for acute lower respiratory tract infection: a randomized controlled trial. JAMA. 2005 Jun 22;293(24):3029–35. doi: 10.1001/jama.293.24.3029 15972565

13. Dowell J, Pitkethly M, Bain J, Martin S. A randomised controlled trial of delayed antibiotic prescribing as a strategy for managing uncomplicated respiratory tract infection in primary care. Br J Gen Pract. 2001 Mar;51(464):200–5. 11255901

14. Little P, Gould C, Williamson I, Moore M, Warner G, Dunleavey J. Pragmatic randomised controlled trial of two prescribing strategies for childhood acute otitis media. BMJ. 2001 Feb 10;322(7282):336–42. doi: 10.1136/bmj.322.7282.336 11159657

15. Cates C. An evidence based approach to reducing antibiotic use in children with acute otitis media: controlled before and after study. BMJ. 1999;318:715–16. doi: 10.1136/bmj.318.7185.715 10074019

16. Little P, Williamson I, Warner G, Gould C, Gantley M, Kinmonth AL. Open randomised trial of prescribing strategies in managing sore throat. BMJ. 1997 Mar 8;314(7082):722–7. doi: 10.1136/bmj.314.7082.722 9116551

17. Høye S, Frich JC, Lindbæk M. Use and feasibility of delayed prescribing for respiratory tract infections: a questionnaire survey. BMC Fam Pract. 2011 May 18;12:34. doi: 10.1186/1471-2296-12-34 21592334

18. McDermott L, Leydon GM, Halls A, Kelly J, Nagle A, White J, et al. Qualitative interview study of antibiotics and self-management strategies for respiratory infections in primary care. BMJ Open. 2017;7:e016903 29180593

19. Francis NA, Gillespie D, Nuttall J, Hood K, Little P, Verheij T, et al. Delayed antibiotic prescribing and associated antibiotic consumption in adults with acute cough. Br J Gen Pract. 2012 Sep;62(602):e639–46 22947585

20. European Centre for Disease Prevention and Control. Summary of the latest data on antibiotic consumption in the European Union: ESAC-Net surveillance data. Stockholm: ECDC; 2017.

21. TNS Opinion & Social. Special eurobarometer 478: antimicrobial resistance. Brussels, Belgium: European Commission; 2018.

22. Saliba-Gustafsson EA, Dunberger Hampton A, Zarb P, Borg MA, Stålsby Lundborg C. Antibiotic prescribing for respiratory tract complaints in Malta: a 1 year repeated cross-sectional surveillance study. J Antimicrob Chemother. 2019 Apr 1;74(4):1116–24. doi: 10.1093/jac/dky544 30624733

23. National Antibiotic Committee. Information for Healthcare Professionals [Internet]. [cited 28 Jun 2018]. http://deputyprimeminister.gov.mt/en/nac/Pages/Information-for-Healthcare-Professionals.aspx.

24. Saliba-Gustafsson EA, Borg MA, Rosales-Klintz S, Nyberg A, Stålsby Lundborg C. Maltese Antibiotic Stewardship Programme in the Community (MASPIC): protocol of a prospective quasiexperimental social marketing intervention. BMJ Open. 2017 Sep 24;7(9):e017992 28947463

25. Röing M, Holmström IK, Larsson J. A metasynthesis of phenomenographic articles on understandings of work among healthcare professionals. Qual Health Res. 2018 Jan;28(2):273–91. doi: 10.1177/1049732317719433 28715988

26. Björkman I, Erntell M, Röing M, Stålsby Lundborg C. Infectious disease management in primary care: perceptions of GPs. BMC Fam Pract. 2011 Jan 11;12:1. doi: 10.1186/1471-2296-12-1 21223592

27. Björkman I, Berg J, Röing M, Erntell M, Stålsby Lundborg C. Perceptions among Swedish hospital physicians on prescribing of antibiotics and antibiotic resistance. Qual Saf Health Care. 2010 Dec;19(6):e8. doi: 10.1136/qshc.2008.029199 20595720

28. Rahmner PB, Gustafsson LL, Holmström I, Rosenqvist U, Tomson G. Whose job is it anyway? Swedish general practitioners’ perception of their responsibility for the patient’s drug list. Ann Fam Med. 2010 Jan-Feb;8(1):40–6. doi: 10.1370/afm.1074 20065277

29. Röing M, Hirsch JM, Holmström I. Ways of understanding the encounter with head and neck cancer patients in the hospital dental team: a phenomenographic study. Support Care Cancer. 2006 Oct;14(10):1046–54. doi: 10.1007/s00520-006-0043-8 16572314

30. Stålsby Lundborg C, Wahlström R, Dall’Alba G. Ways of experiencing asthma management. Variations among general practitioners in Sweden. Scand J Prim Health Care. 1999 Dec;17(4):226–31. doi: 10.1080/028134399750002458 10674300

31. Marton F. Phenomenography: a research approach to investigating different understandings of reality. J Thought. 1986;21(3):28–49.

32. Marton F, Booth S. Learning and awareness. Mahwah, NJ: Lawrence Erlbaum; 1997.

33. Azzopardi-Muscat N, Buttigieg S, Calleja N, Merkur S. Malta: health system review. Health Systems in Transition. 2017;19(1):1–137. 28485715

34. PricewaterhouseCoopers. Healthcare delivery in Malta. Malta: PricewaterhouseCoopers; 2012.

35. Borg MA, Scicluna EA. Over-the-counter acquisition of antibiotics in the Maltese general population. Int J Antimicrob Agents. 2002 Oct;20(4):253–7. doi: 10.1016/s0924-8579(02)00194-2 12385680

36. Dahlgren LO, Fallsberg M. Phenomenography as a qualitative approach in social pharmacy research. J Soc Adm Pharm. 1991;8(4):150–6.

37. Yates C, Partridge H, Bruce C. Exploring information experiences through phenomenography. Libr Inf Res. 2012;36(112):96–119.

38. Peters S, Rowbotham S, Chisholm A, Wearden A, Moschogianis S, Cordingley L, et al. Managing self-limiting respiratory tract infections: a qualitative study of the usefulness of the delayed prescribing strategy. Br J Gen Pract. 2011 Sep;61(590):e579–89. doi: 10.3399/bjgp11X593866 22152745

39. Petursson P. GPs’ reasons for “non-pharmacological” prescribing of antibiotics: a phenomenological study. Scand J Prim Health Care. 2005 Jun;23(2):120–5. doi: 10.1080/02813430510018491 16036552

40. Butler CC, Rollnick S, Pill R, Maggs-Rapport F, Stott N. Understanding the culture of prescribing: qualitative study of general practitioners’ and patients’ perceptions of antibiotics for sore throats. BMJ. 1998;317:637–42. doi: 10.1136/bmj.317.7159.637 9727992

41. Björnsdóttir I, Hansen EH. Intentions, strategies and uncertainty inherent in antibiotic prescribing. Eur J Gen Pract. 2002;8(1):18–24.

42. Kumar S, Little P, Britten N. Why do general practitioners prescribe antibiotics for sore throat? Grounded theory interview study. BMJ. 2003 Jan 18;326(7381):138. doi: 10.1136/bmj.326.7381.138 12531847

43. Arroll B, Goodyear-Smith F, Thomas DR, Kerse N. Delayed antibiotic prescriptions: what are the experiences and attitudes of physicians and patients? J Fam Pract. 2002 Nov;51(11): 954–9. 12485551

44. Lum EPM, Page K, Whitty JA, Doust J, Graves N. Antibiotic prescribing in primary healthcare: dominant factors and trade-offs in decision-making. Infect Dis Health. 2018 Jun;23(2):74–86.

45. Høye S, Frich J, Lindbœk M. Delayed prescribing for upper respiratory tract infections: a qualitative study of GPs’ views and experiences. Br J Gen Pract. 2010 Dec;60(581):907–12. doi: 10.3399/bjgp10X544087 21144201

46. Ryves R, Eyles C, Moore M, McDermott L, Little P, Leydon GM. Understanding the delayed prescribing of antibiotics for respiratory tract infection in primary care: a qualitative analysis. BMJ Open. 2016 Nov 18;6(11):e011882. doi: 10.1136/bmjopen-2016-011882 27864242

47. Spurling GKP, Del Mar CB, Dooley L, Foxlee R, Farley R. Delayed antibiotics for respiratory infections. Cochrane Database Syst Rev. 2013;CD004417.

48. Touboul-Lundgren P, Jensen S, Drai J, Lindbæk M. Identification of cultural determinants of antibiotic use cited in primary care in Europe: a mixed research synthesis study of integrated design “Culture is all around us”. BMC Public Health. 2015 Sept 17;15:908. doi: 10.1186/s12889-015-2254-8 26381376

49. Hofstede G, Hofstede G, Minkov M. Cultures and organisations: software of the mind. New York, USA: McGraw-Hill; 2010.

50. Gaygısız Ü, Lajunen T, Gaygısız E. Socio-economic factors, cultural values, national personality and antibiotics use: a cross-cultural study among European countries. J Infect Public Health. 2017 Nov-Dec;10(6):755–60. doi: 10.1016/j.jiph.2016.11.011 28209467

51. Borg MA. National cultural dimensions as drivers of inappropriate ambulatory care consumption of antibiotics in Europe and their relevance to awareness campaigns. J Antimicrob Chemother. 2012 Mar;67(3):763–7. doi: 10.1093/jac/dkr541 22200725

52. Deschepper R, Grigoryan L, Stålsby Lundborg C, Hofstede G, Cohen J, Kelen GVD, et al. Are cultural dimensions relevant for explaining cross-national differences in antibiotic use in Europe? BMC Health Serv Res. 2008 Jun 6;8:123. doi: 10.1186/1472-6963-8-123 18538009

53. Raft CF, Bjerrum L, Arpi M, Jarløv JO, Jensen JN. Delayed antibiotic prescription for upper respiratory tract infections in children under primary care: physicians’ views. Eur J Gen Pract. 2017 Dec;23(1):190–5. doi: 10.1080/13814788.2017.1347628 28714782

54. Cals JWL, Schot MJC, de Jong SAM, Dinant GJ, Hopstaken RM. Point-of-care C-reactive protein testing and antibiotic prescribing for respiratory tract infections: a randomized controlled trial. Ann Fam Med. 2010 Mar-Apr;8(2):124–33. doi: 10.1370/afm.1090 20212299

55. Llor C, Madurell J, Balagué-Corbella M, Gómez M, Cots JM. Impact on antibiotic prescription of rapid antigen detection testing in acute pharyngitis in adults: a randomised clinical trial. Br J Gen Pract. 2011 May;61(586):e244–51. doi: 10.3399/bjgp11X572436 21619748

56. National Institute for Health and Care Excellence. Respiratory tract infections (self-limiting): prescribing antibiotics [Internet]. 2008 [cited 4 Jul 2018]. https://www.nice.org.uk/guidance/CG69.

57. Mack N, Woodsong C, MacQueen KM, Guest G, Namey E. Qualitative research methods: a data collector’s field guide. North Carolina: Family Health International; 2005.

58. Arroll B, Kenealy T, Kerse N. Do delayed prescriptions reduce antibiotic use in respiratory tract infections? A systematic review. Br J Gen Pract. 2003 Nov;53(496):871–7. 14702908


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