Rational antibiotic prescribing in primary care: qualitative study of opportunities and obstacles

BACKGROUND: The Swedish strategic programme against antibiotic resistance (Strama) has worked towards rational use of antibiotics, and Swedish antibiotic prescribing is low. AIM: To explore how opportunities and obstacles for rational antibiotic prescribing were perceived by primary health care centres (PHCCs). DESIGN & SETTING: A qualitative study of 50 randomly selected reports from approximately 200 PHCCs in 2013 and 2016 in Region Västra Götaland, Sweden. METHOD: One assigned GP at each PHCC reported yearly in an open-ended questionnaire on how the PHCC worked to improve antibiotic prescribing. The report included several antibiotic-related tasks and a summary of reflective meetings with the doctors, the head of the PHCC, and, preferably, also the nurses. The reports were qualitatively analysed using Malterud’s systematic text condensation (STC). RESULTS: 'Everyone wants to do right, but sometimes you do not know what's right or wrong.' Knowledge about diagnosis and treatment of infectious diseases was highlighted. Knowledge and skills had to be internalised by the clinician in order to bring about behavioural change. This could be achieved through reflective, collegial dialogues where consensus often was found. Structural factors at the PHCC could provide good conditions for 'doing right', but could also constitute obstacles. Teamwork involving all personnel was important to achieve rational antibiotic prescribing. CONCLUSION: Enablers for rational antibiotic prescribing were knowledge, reflective collegial dialogues, a well organised workplace, and a collaborating team. Obstacles were lack of knowledge, insufficient staffing, perceived lack of time, and overuse of laboratory tests. Patients’ attitudes and expectations could be both.