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Understanding General Practitioners’ Antibiotic Prescribing Decisions in Out-of-Hours Primary Care: A Video-Elicitation Interview Study

Infections are the most common reason why patients consult out-of-hours (OOH) primary care. Too often there is an overprescribing of antibiotics for self-limiting infections and general practitioners (GPs) do not always choose the guideline recommended antibiotics. To improve antibiotic prescribing...

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Autores principales: Colliers, Annelies, Coenen, Samuel, Bombeke, Katrien, Remmen, Roy, Philips, Hilde, Anthierens, Sibyl
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7148451/
https://www.ncbi.nlm.nih.gov/pubmed/32156082
http://dx.doi.org/10.3390/antibiotics9030115
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author Colliers, Annelies
Coenen, Samuel
Bombeke, Katrien
Remmen, Roy
Philips, Hilde
Anthierens, Sibyl
author_facet Colliers, Annelies
Coenen, Samuel
Bombeke, Katrien
Remmen, Roy
Philips, Hilde
Anthierens, Sibyl
author_sort Colliers, Annelies
collection PubMed
description Infections are the most common reason why patients consult out-of-hours (OOH) primary care. Too often there is an overprescribing of antibiotics for self-limiting infections and general practitioners (GPs) do not always choose the guideline recommended antibiotics. To improve antibiotic prescribing quality, a better understanding is needed of the (non) antibiotic prescribing decisions of GPs. This study sets out to unravel GPs’ (non) antibiotic prescribing decisions in OOH primary care. We video-recorded 160 consultations on infections during OOH primary care by 21 GPs and performed video-elicitation interviews with each GP. GPs reflected on their decision-making process and communication while watching their consultation. A qualitative thematic analysis was used. GPs found that their (non) antibiotic prescribing decision-making was not only based on objective arguments, but also subconsciously influenced by their own interpretation of information. Often GPs made assumptions (about for example the patients’ reason for encounter or expectations for antibiotics) without objectifying or verifying this with the patient. From the beginning of the consultation GPs follow a dichotomous thinking process: urgent versus not urgent, viral versus bacterial, antibiotics versus no antibiotics. Safety-netting is an important but difficult tool in the OOH care context, with no long-term follow-up or relationship with the patient. GPs talk about strategies they use to talk about diagnostic uncertainty, what patients can expect or should do when things do not improve and the difficulties they encounter while doing this. This video- elicitation interview study provides actionable insights in GPs’ (non) antibiotic prescribing decisions during OOH consultations on infections.
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spelling pubmed-71484512020-04-21 Understanding General Practitioners’ Antibiotic Prescribing Decisions in Out-of-Hours Primary Care: A Video-Elicitation Interview Study Colliers, Annelies Coenen, Samuel Bombeke, Katrien Remmen, Roy Philips, Hilde Anthierens, Sibyl Antibiotics (Basel) Article Infections are the most common reason why patients consult out-of-hours (OOH) primary care. Too often there is an overprescribing of antibiotics for self-limiting infections and general practitioners (GPs) do not always choose the guideline recommended antibiotics. To improve antibiotic prescribing quality, a better understanding is needed of the (non) antibiotic prescribing decisions of GPs. This study sets out to unravel GPs’ (non) antibiotic prescribing decisions in OOH primary care. We video-recorded 160 consultations on infections during OOH primary care by 21 GPs and performed video-elicitation interviews with each GP. GPs reflected on their decision-making process and communication while watching their consultation. A qualitative thematic analysis was used. GPs found that their (non) antibiotic prescribing decision-making was not only based on objective arguments, but also subconsciously influenced by their own interpretation of information. Often GPs made assumptions (about for example the patients’ reason for encounter or expectations for antibiotics) without objectifying or verifying this with the patient. From the beginning of the consultation GPs follow a dichotomous thinking process: urgent versus not urgent, viral versus bacterial, antibiotics versus no antibiotics. Safety-netting is an important but difficult tool in the OOH care context, with no long-term follow-up or relationship with the patient. GPs talk about strategies they use to talk about diagnostic uncertainty, what patients can expect or should do when things do not improve and the difficulties they encounter while doing this. This video- elicitation interview study provides actionable insights in GPs’ (non) antibiotic prescribing decisions during OOH consultations on infections. MDPI 2020-03-07 /pmc/articles/PMC7148451/ /pubmed/32156082 http://dx.doi.org/10.3390/antibiotics9030115 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Colliers, Annelies
Coenen, Samuel
Bombeke, Katrien
Remmen, Roy
Philips, Hilde
Anthierens, Sibyl
Understanding General Practitioners’ Antibiotic Prescribing Decisions in Out-of-Hours Primary Care: A Video-Elicitation Interview Study
title Understanding General Practitioners’ Antibiotic Prescribing Decisions in Out-of-Hours Primary Care: A Video-Elicitation Interview Study
title_full Understanding General Practitioners’ Antibiotic Prescribing Decisions in Out-of-Hours Primary Care: A Video-Elicitation Interview Study
title_fullStr Understanding General Practitioners’ Antibiotic Prescribing Decisions in Out-of-Hours Primary Care: A Video-Elicitation Interview Study
title_full_unstemmed Understanding General Practitioners’ Antibiotic Prescribing Decisions in Out-of-Hours Primary Care: A Video-Elicitation Interview Study
title_short Understanding General Practitioners’ Antibiotic Prescribing Decisions in Out-of-Hours Primary Care: A Video-Elicitation Interview Study
title_sort understanding general practitioners’ antibiotic prescribing decisions in out-of-hours primary care: a video-elicitation interview study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7148451/
https://www.ncbi.nlm.nih.gov/pubmed/32156082
http://dx.doi.org/10.3390/antibiotics9030115
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