Antibiotic Prescribing and Doctor-Patient Communication During Consultations for Respiratory Tract Infections: A Video Observation Study in Out-of-Hours Primary Care

Abstract

Objective: Communication skills can reduce inappropriate antibiotic prescribing, which could help to tackle antibiotic resistance. General practitioners often overestimate patient expectations for an antibiotic. In this study, we describe how general practitioners and patients with respiratory tract infections (RTI) communicate about their problem, including the reason for encounter and ideas, concerns, and expectations (ICE), and how this relates to (non-)antibiotic prescribing in out-of-hours (OOH) primary care.Methods: A qualitative descriptive framework analysis of video-recorded consultations during OOH primary care focusing on doctor-patient communication.Results: We analyzed 77 videos from 19 general practitioners. General practitioners using patient-centered communication skills received more information on the perspective of the patients on the illness period. For some patients, the reason for the encounter was motivated by their belief that a general practitioner (GP) visit will alter the course of their illness. The ideas, concerns, and expectations often remained implicit, but the concerns were expressed by the choice of words, tone of voice, repetition of words, etc. Delayed prescribing was sometimes used to respond to implicit patient expectations for an antibiotic. Patients accepted a non-antibiotic management plan well.Conclusion: Not addressing the ICE of patients, or their reason to consult the GP OOH, could drive assumptions about patient expectations for antibiotics early on and antibiotic prescribing later in the consultation.

The moderating effect of parental skills for antibiotic identification on the link between parental skills for antibiotic use and inappropriate antibiotic use for children in China

“…Similarly, the Chinese government can indicate whether the drug is an antibiotic on drug packaging, and antibiotic identification campaigns included in the daily activities of guidance for rational drug use in schools and communities through a variety of media forms were recommended. In addition, barriers in doctor-patient communication often lead to a stronger willingness for doctors to use antibiotics in patients [ 36 ]. Patients and their caregivers often challenge doctors’ authority by rejecting treatment recommendations and such pressure may increase physician prescribing behavior [ 37 , 38 ].…”

Development and Psychometric Evaluation of the Antibiotic Knowledge and Consumption Tool (AKCT)

“…This approach led to higher patient satisfaction, reducing late arising concerns, and improving understanding, time management, treatment adherence, and health outcomes. Findings showed that general practitioners who made room for the story of patients by using active listening techniques received more information about the ideas, concerns, and expectations (ICEs) and were able to successfully reassure patients that there was no reason to give antibiotics [ 41 ].…”

The value, challenges and practical considerations of conducting qualitative research on antimicrobial stewardship in primary care

“… 55 A recent development in the area of non-participant observation includes an increasing use of video recordings. 19 , 33 , 34 This can be a useful data collection approach in primary care research particularly when studying patient–clinician communication practices related to AMS. 34 , 35 , 56 …”

“… 19 , 33 , 34 This can be a useful data collection approach in primary care research particularly when studying patient–clinician communication practices related to AMS. 34 , 35 , 56 …”