Diagnosing infections: a qualitative view on prescription decisions in general practice over time

Björnsdóttir, Ingunn; Kristinsson, Karl G.; Hansen, Ebba Holme

doi:10.1007/s11096-010-9441-6

Cited by 49 publications

(45 citation statements)

References 22 publications

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“…Previous studies have reported that increasing the awareness about antibiotic resistance would potentially influence GPs’ decisions in selecting antibiotics, underlining the importance of knowledge about MDR organisms in assisting clinical decisions [18, 21, 22]. Furthermore, education that promotes awareness about antibiotic resistance is likely to encourage more microbiological testing to identify causative organisms before initiating antibiotic treatment.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial stewardship in residential aged care facilities: need and readiness assessment

et al. 2014

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BackgroundInformation about the feasibility, barriers and facilitators of antimicrobial stewardship (AMS) in residential aged care facilities (RACFs) has been scant. Exploring the prevailing perceptions and attitudes of key healthcare providers towards antibiotic prescribing behaviour, antibiotic resistance and AMS in the RACF setting is imperative to guide AMS interventions.MethodsSemi-structured interviews and focus groups were conducted with key RACF healthcare providers until saturation of themes occurred. Participants were recruited using purposive and snowball sampling. The framework approach was applied for data analysis.ResultsA total of 40 nurses, 15 general practitioners (GPs) and 6 pharmacists from 12 RACFs were recruited. Five major themes emerged; perceptions of current antibiotic prescribing behaviour, perceptions of antibiotic resistance, attitude towards and understanding of AMS, perceived barriers to and facilitators of AMS implementation, and feasible AMS interventions. A higher proportion of GPs and pharmacists compared with nurses felt there was over-prescribing of antibiotics in the RACF setting. Antibiotic resistance was generally perceived as an issue for infection control rather than impacting clinical decisions. All key stakeholders were supportive of AMS implementation in RACFs; however, they recognized barriers related to workload and logistical issues. A range of practical AMS interventions were identified, with nursing-based education, aged-care specific antibiotic guidelines and regular antibiotic surveillance deemed most useful and feasible.ConclusionsAreas of antibiotic over-prescribing have been identified from different healthcare providers’ perspectives. However, concern about the clinical impact of antibiotic resistance was generally lacking. Importantly, information gathered about feasibility, barriers and facilitators of various AMS interventions will provide important insights to guide development of AMS programs in the RACF setting.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-410) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Antimicrobial stewardship in residential aged care facilities: need and readiness assessment

et al. 2014

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“…Individual clinician prescribing habits, rather than clinical presentation, have been shown to best predict antibiotic prescription, 25 and these habits tend to remain stable over time. 26 Given that trainees come to resemble their supervisors, the problem of antibiotic overprescription will not decrease in the future without intervention.…”

Section: 24mentioning

confidence: 99%

Antibiotic prescribing for the future: exploring the attitudes of trainees in general practice

et al. 2014

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ResultsRegistrars were aware of the importance of evidence-based antibiotic prescribing and the impact of their decisions on resistance. Many expressed a sense of dissonance between their knowledge and behaviours. Contextual influences on their decisions included patient and system factors, diagnostic uncertainty, transitioning from hospital medicine, and the habits of, and relationship with, their supervisor. ConclusionUnderstanding how trainees in general practice perceive and develop antibiotic prescribing habits will enable targeted educational interventions to be designed and implemented at a crucial stage in training, working towards ensuring appropriate antibiotic prescribing in the future.

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“…17 There was a total of 383 patients (154 males, 229 females). We processed the data and looked at EMIS consultation records of 102 patients who were selected randomly based on their EMIS numbers.…”

Section: Baseline Measurement Search Tools and Data Collectionmentioning

confidence: 99%

Improving antimicrobial prescribing practice for sore throat symptoms in a general practice setting

Razai¹,

Hussain²

2017

BMJ Qual Improv Report

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Acute sore throat is a common presentation in primary care settings. We aimed to improve our compliance with national antibiotic guidelines for sore throat symptoms to 90% in 3 months' time period. The national guidelines are based on Centor criteria. A retrospective audit of 102 patient records with sore throat symptoms presenting between 1 January to 30 December 2015 showed that over 50% were given antibiotics. Those who were prescribed antibiotics, 27% did not meet NICE criteria and 85% of patients were given immediate antibiotic prescription. Centor criteria was documented in just 2% of cases. Compliance with correct antibiotic course length was 15%. Antibiotic choice and dose was correct in 94% and 92% of cases respectively. Antibiotic frequency was correctly prescribed in 100% of patients.We introduced interventions that included oral and poster presentations to multidisciplinary team, dissemination of guidelines through internal e-mail and systemic changes to GP electronic patient record system EMIS. This involved creating an automated sore throat template and information page. On re-auditing of 71 patients, after two PDSA cycles, compliance with NICE criteria was 87% with a significant reduction in immediate prescribing (66%). Centor criteria documentation was 42%. Correct antibiotic course length was prescribed in over 30% of cases. Other antibiotic regimen parameters (choice, dose and frequency) were correct in 100% of cases.The initial results demonstrated that significant changes were needed. In particular, reducing the amount of antibiotics prescribed by increasing compliance with NICE criteria and ensuring all parameters of antibiotic prescription were correct. We showed that significant sustainable improvement is achievable through carefully devised automated systemic changes that provides critical information in readily accessible format, and does not solely rely on prescribers' knowledge and initiative. The outcome of these interventions are a decrease in immediate antibiotic prescription, significant increase in Centor criteria documentation and an increase in compliance with the correct course length of antibiotics. All these measures would contribute to reduction in antimicrobial resistance and improvement in patient care in the community. Future work must focus on improving compliance with correct antibiotic course length.

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Diagnosing infections: a qualitative view on prescription decisions in general practice over time

Cited by 49 publications

References 22 publications

Antimicrobial stewardship in residential aged care facilities: need and readiness assessment

Antimicrobial stewardship in residential aged care facilities: need and readiness assessment

Antibiotic prescribing for the future: exploring the attitudes of trainees in general practice

Improving antimicrobial prescribing practice for sore throat symptoms in a general practice setting

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