Enabling factors for antibiotic prescribing for upper respiratory tract infections: Perspectives of Lithuanian and Russian general practitioners

Abstract

Introduction General practitioners (GPs) write about 80% of all antibiotic prescriptions, the greatest number of them for patients with respiratory tract infections. However, there is a lack of research targeting the influence of external factors on antibiotic prescribing by physicians. This study aimed to explore experiences of GPs in Lithuania and the Russian Federation with regard to antibiotic prescription for upper respiratory tract infections. By such means it might be possible to reveal external enabling factors that influence antibiotic prescribing in these countries.Method Five focus groups were performed with 22 GPs from Lithuania and 29 GPs from the Kaliningrad Region of the Russian Federation; then, thematic analysis of data was performed.Results Six thematic categories were identified that are related to external forces enabling antibiotic prescription: the necessity for political leadership to encourage clinically grounded antibiotic use; over-the-counter sale of antibiotics; designation of antibiotics as reimbursable medications; supervision by external oversight institutions; lack of guidelines for the treatment of upper respiratory tract infections; and pharmaceutical company activities.Conclusions Comprehensive efforts to reduce the burden of non-clinically grounded antibiotic prescription should go beyond addressing factors at the physician–patient level and take into account important factors in the enabling environment as well.

Over-the-counter medication patterns in households in Sharjah, United Arab Emirates

“…It was found that the highest percentages of OTC medications among households were those related to gastric symptoms as well as ear, nose, and throat symptoms and complaints, and there is a need to mention the serious harm that such medications can cause on different systems in the body if used without the supervision of a physician. Other studies have concluded that antibiotics and cough medications comprise the highest percentages of purchased OTC medications 13,14…”

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“…However, physicians in Lithuania have now suggested the opposite i.e. no reimbursement for ABs at all, as they believe reimbursement leads to higher consumption [12]. Hence, using reimbursement as a regulatory mean to control use of ABs can be challenging.…”

“…A systematic review published in 2011 found that northeastern European countries, such as Lithuania, Poland and Romania, have a high frequency of OTC sales of ABs (approximately 30%), whereas others have suggested that only approximately 8% of the ABs used in this region are obtained without a prescription [11]. Furthermore, there are indications that OTC sales of ABs have in fact decreased in countries such as Lithuania due to legislation in this area [12]. The review from 2011 also reported that approximately 6% of ABs are sold OTC in some countries in southeastern Europe, i.e., Croatia, Slovenia and Slovakia [13], while other studies have suggested that approximately 50% of ABs are sold OTC in this region [2].…”

Antibiotic prescribing for acute respiratory tract infections in primary care: an updated and expanded meta-ethnography

“…41,61,67 Similarly, for PCPs practising in countries where antibiotic use still remains largely unregulated, they extensively discussed how patients' direct access to antibiotics and self-medication restricted their management options and led to unnecessary prescribing. 25,37,43,44,46,55 By comparison, PCPs from Belgium, Iceland, and the UK emphasised how systems to reduce patient expectations, such as public information campaigns, had made their work easier over the last few years. 43,51 Of note, in the only study that included a follow-up (that is, the same Icelandic GPs were interviewed in 1995 and again in 2006), Björnsdóttir et al 51 found increased use of point-of-care tests and the perception by GPs that patients were more willing to 'wait and see'.…”