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-Ćwirko, Maciek; Melbye, Hasse; Krawczyk, Jaroslaw; Borràs-Santos, Alícia; Jakobsen, Kristin; Worby, Patricia; Goossens, Herman; Butler, Christopher Collett

doi:10.1136/bmjopen-2011-000795

Cited by 54 publications

(52 citation statements)

References 30 publications

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“…18,26 In addition, antibiotics were sometimes prescribed when current evidence indicates they were not needed, eg, for yellow phlegm, 27 a practice observed across many countries. 28 In our study we see how the minimal explanation accompanying antibiotic prescriptions can confirm parents' beliefs about what indicates severity and a need for antibiotics. Most parents are seeking a medical evaluation and defer to the clinician for the treatment decision, 14 but when they perceive the illness to be more severe, they may have a higher expectation of antibiotic treatment.…”

Section: Discussionmentioning

confidence: 57%

Influence of Clinical Communication on Parents’ Antibiotic Expectations for Children With Respiratory Tract Infections

et al. 2016

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PURPOSE The purpose of this study was to understand clinicians' and parents' perceptions of communication within consultations for respiratory tract infections (RTI) in children and what influence clinician communication had on parents' understanding of antibiotic treatment. METHODSWe video recorded 60 primary care consultations for children aged 3 months to 12 years who presented with RTI and cough in 6 primary care practices in England. We then used purposive sampling to select 27 parents and 13 clinicians for semistructured video-elicitation interviews. The videos were used as prompts to investigate participants' understanding and views of communication within the consultations. We analyzed the interview data thematically. RESULTSWhile clinicians commonly told parents that antibiotics are not effective against viruses, this did not have much impact on parents' beliefs about the need to consult or on their expectations concerning antibiotics. Parents believed that antibiotics were needed to treat more severe illnesses, a belief that was supported by the way clinicians accompanied viral diagnoses with problemminimizing language and antibiotic prescriptions with more problem-oriented language. Antibiotic prescriptions tended to confirm parents' beliefs about what indicated illness severity, which often took into account the wider impact on a child's life. While parents understood antimicrobial resistance poorly, most held beliefs that supported reduced antibiotic prescribing. A minority attributed it to resource rationing, however.CONCLUSIONS Clinician communication and prescribing behavior confirm parents' beliefs that antibiotics are needed to treat more severe illnesses. Interventions to reduce antibiotic expectations need to address communication within the consultation, prescribing behavior, and lay beliefs. Ann Fam Med 2016;14:141-147. doi: 10.1370/afm.1892. INTRODUCTIONA ntibiotic resistance presents a major strategic risk to health services; without effective antibiotics, mortality rates from infectious illness and surgery would increase markedly.1 Around 80% of antibiotics are prescribed in primary care, most commonly for respiratory tract infections (RTI).2 Despite a range of initiatives to reduce the use of antibiotics, antibiotic prescribing for coughs and colds (upper RTI) in the United Kingdom has been increasing gradually since 1999.3 The use of antibiotics is an important driver of antibiotic resistance, 4,5 which has the potential to result in increasing mortality rates from infectious disease. 1Patient and parent expectation of antibiotic treatment has been identified as a driver of antibiotic prescribing by clinicians. [6][7][8] Numerous campaigns have attempted to increase public awareness of appropriate use of antibiotics, many aiming to communicate the message that most RTIs are caused by viruses and cannot be treated with antibiotics.9 Greater public knowledge, however, does not necessarily lead to reduced consumption of antibiotics. 142The communication occurring within the consu...

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Section: Discussionmentioning

confidence: 57%

Influence of Clinical Communication on Parents’ Antibiotic Expectations for Children With Respiratory Tract Infections

et al. 2016

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“…[8,9]. In the era of emerging antimicrobial resistance, regular monitoring of antimicrobial susceptibility patterns, changing prescription patterns, cautious and judicious use of antibiotics will be of extreme importance in better patient care [10,11,12]. There are only fewer studies reported in literature regarding the aetiology and antimicrobial susceptibility patterns of the LRTI's from this particular geographical region and this is the first time we are reporting from our institution.…”

Section: Introductionmentioning

confidence: 78%

Aetiology and Antimicrobial Susceptibility Patterns of Lower Respiratory Tract Infections (LRTI) in a Rural Tertiary Care Teaching Hospital in Karimnagar, South India

Ramana¹,

Kalaskar²,

Rao³

et al. 2013

AJIDM

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Lower respiratory tract infections (LRTI's) are amongst the most common causes of morbidity and mortality arising from infectious diseases both in the developed and developing nations. Prompt clinical and laboratory diagnosis along with appropriate treatment strategies would be helpful in the management of both community and nosocomially acquired LRTI's. The present study was aimed at evaluating the aetiology and antimicrobial susceptibility patterns of LRTI's in a tertiary care teaching hospital in south India. The results revealed that among the samples tested 56 (52.83%) were positive for various bacteria, 6 (5.6%) were showing the growth of fungi and 44 (41.5%) were revealing no pathogens. Klebsiella pneumoniae (45.1%) was the predominant Gram negative bacterial pathogen isolated followed by Citrobacter freundii (12.9%), Pseudomonas aeruginosa (9.6%), Staphylococcus aureus (9.6%) was the significant Gram positive bacterial pathogen followed by Streptococcus pneumoniae (5.6%). The antimicrobial susceptibility pattern of the isolated bacteria indicated the presence of multidrug resistance, Extended spectrum beta lactamases (ESBL) (75%) and metallobetalactamases/carbapenemases (MBL) (25%) among the Gram negative bacterial isolates whereas MRSA (16.6%) and VRSA (16%) among the Gram positive bacterial isolates. With varied geographical prevalence, and different antimicrobial susceptibility patterns, it becomes imperative to regularly evaluate the aetiology and antibiotic profiles of LRTI's and formulate regional guidelines that guide clinical, laboratory diagnosis and management of patients suffering from LRTI's.

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“…We identified a skewed distribution in provider claims volume and drug prescribing diversity, with most participating providers making relatively few claims of a small number of drug types. Previously, a number of focused studies have examined prescription diversity, mostly with respect to opioid analgesics [52][53][54][55][56][57][58], antibiotics [1,[59][60][61][62][63], psychiatric medications [64][65][66][67], and among general practitioners [31,[68][69][70][71][72]. One web site has made the Medicare Part D prescribing data searchable with varios filters for provider, charges, and medications [73][74][75].…”

Section: Discussionmentioning

confidence: 99%

Visualizing nationwide variation in Medicare Part D prescribing patterns

Rosenberg

Fucile

White

et al. 2017

Preprint

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Objective To characterize the regional and national variation in prescribing patterns in the Medicare Part D program using machine learning and dimensional reduction visualization methods. Methods Using publicly available Medicare Part D claims data, we identified regional and national provider prescribing profile variation with unsupervised clustering and t-distributed stochastic neighbor embedding (t-SNE) dimensional reduction techniques. Additionally, we examined differences between regionally representative prescribing patterns for major metropolitan areas. Results Distributions of prescribing volume and medication diversity were highly skewed among over 800,000 Medicare Part D providers, and medical specialties had characteristic prescribing patterns. Although the number of Medicare providers in each state was highly correlated with the number of Medicare Part D enrollees, some states were enriched for providers with >10,000 prescription claims annually. Hierarchical clustering and t-SNE dimension-reduction visualization of drug-or drug-class prescribing patterns revealed that providers cluster strongly based on specialty and sub-specialty, with large regional variations in prescribing patterns. Major metropolitan areas had distinct prescribing patterns that tended to group by major geographical divisions. Conclusions There is substantial prescribing variation among providers in Medicare Part D both between and within specialties. Large regional variations in prescribing patterns, particularly among major metropolitan areas, were also seen. Unsupervised clustering and t-SNE dimension-reduction are an effective means to examine variation in provider prescribing patterns, including substantial regional and medical specialty variation.

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Clinical influences on antibiotic prescribing decisions for lower respiratory tract infection: a nine country qualitative study of variation in care

Cited by 54 publications

References 30 publications

Influence of Clinical Communication on Parents’ Antibiotic Expectations for Children With Respiratory Tract Infections

Influence of Clinical Communication on Parents’ Antibiotic Expectations for Children With Respiratory Tract Infections

Aetiology and Antimicrobial Susceptibility Patterns of Lower Respiratory Tract Infections (LRTI) in a Rural Tertiary Care Teaching Hospital in Karimnagar, South India

Visualizing nationwide variation in Medicare Part D prescribing patterns

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