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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 var...

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Autores principales: Brookes-Howell, Lucy, Hood, Kerenza, Cooper, Lucy, Coenen, Samuel, Little, Paul, Verheij, Theo, Godycki-Cwirko, Maciek, Melbye, Hasse, Krawczyk, Jaroslaw, Borras-Santos, Alicia, Jakobsen, Kristin, Worby, Patricia, Goossens, Herman, Butler, Christopher C
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Group 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3364454/
https://www.ncbi.nlm.nih.gov/pubmed/22619265
http://dx.doi.org/10.1136/bmjopen-2011-000795
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author Brookes-Howell, Lucy
Hood, Kerenza
Cooper, Lucy
Coenen, Samuel
Little, Paul
Verheij, Theo
Godycki-Cwirko, Maciek
Melbye, Hasse
Krawczyk, Jaroslaw
Borras-Santos, Alicia
Jakobsen, Kristin
Worby, Patricia
Goossens, Herman
Butler, Christopher C
author_facet Brookes-Howell, Lucy
Hood, Kerenza
Cooper, Lucy
Coenen, Samuel
Little, Paul
Verheij, Theo
Godycki-Cwirko, Maciek
Melbye, Hasse
Krawczyk, Jaroslaw
Borras-Santos, Alicia
Jakobsen, Kristin
Worby, Patricia
Goossens, Herman
Butler, Christopher C
author_sort Brookes-Howell, Lucy
collection PubMed
description 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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spelling pubmed-33644542012-06-04 Clinical influences on antibiotic prescribing decisions for lower respiratory tract infection: a nine country qualitative study of variation in care Brookes-Howell, Lucy Hood, Kerenza Cooper, Lucy Coenen, Samuel Little, Paul Verheij, Theo Godycki-Cwirko, Maciek Melbye, Hasse Krawczyk, Jaroslaw Borras-Santos, Alicia Jakobsen, Kristin Worby, Patricia Goossens, Herman Butler, Christopher C BMJ Open General practice / Family practice 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. BMJ Group 2012-05-22 /pmc/articles/PMC3364454/ /pubmed/22619265 http://dx.doi.org/10.1136/bmjopen-2011-000795 Text en © 2012, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.
spellingShingle General practice / Family practice
Brookes-Howell, Lucy
Hood, Kerenza
Cooper, Lucy
Coenen, Samuel
Little, Paul
Verheij, Theo
Godycki-Cwirko, Maciek
Melbye, Hasse
Krawczyk, Jaroslaw
Borras-Santos, Alicia
Jakobsen, Kristin
Worby, Patricia
Goossens, Herman
Butler, Christopher C
Clinical influences on antibiotic prescribing decisions for lower respiratory tract infection: a nine country qualitative study of variation in care
title Clinical influences on antibiotic prescribing decisions for lower respiratory tract infection: a nine country qualitative study of variation in care
title_full Clinical influences on antibiotic prescribing decisions for lower respiratory tract infection: a nine country qualitative study of variation in care
title_fullStr Clinical influences on antibiotic prescribing decisions for lower respiratory tract infection: a nine country qualitative study of variation in care
title_full_unstemmed Clinical influences on antibiotic prescribing decisions for lower respiratory tract infection: a nine country qualitative study of variation in care
title_short Clinical influences on antibiotic prescribing decisions for lower respiratory tract infection: a nine country qualitative study of variation in care
title_sort clinical influences on antibiotic prescribing decisions for lower respiratory tract infection: a nine country qualitative study of variation in care
topic General practice / Family practice
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3364454/
https://www.ncbi.nlm.nih.gov/pubmed/22619265
http://dx.doi.org/10.1136/bmjopen-2011-000795
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