Empowering Patients to Self-Manage Common Infections: Qualitative Study Informing the Development of an Evidence-Based Patient Information Leaflet

Abstract

Common self-limiting infections can be self-managed by patients, potentially reducing consultations and unnecessary antibiotic use. This qualitative study informed by the Theoretical Domains Framework (TDF) aimed to explore healthcare professionals’ (HCPs) and patients’ needs on provision of self-care and safety-netting advice for common infections. Twenty-seven patients and seven HCPs participated in semi-structured focus groups (FGs) and interviews. An information leaflet was iteratively developed and reviewed by participants in interviews and FGs, and an additional 5 HCPs, and 25 patients (identifying from minority ethnic groups) via online questionnaires. Qualitative data were analysed thematically, double-coded, and mapped to the TDF. Participants required information on symptom duration, safety netting, self-care, and antibiotics. Patients felt confident to self-care and were averse to consulting with HCPs unnecessarily but struggled to assess symptom severity. Patients reported seeking help for children or elderly dependents earlier. HCPs’ concerns included patients’ attitudes and a lack of available monitoring of advice given to patients. Participants believed community pharmacy should be the first place that patients seek advice on common infections. The patient information leaflet on common infections should be used in primary care and community pharmacy to support patients to self-manage symptoms and determine when further help is required.

Mixed-Method Evaluation of a Community Pharmacy Antimicrobial Stewardship Intervention (PAMSI)

“…The TARGET treating your infection leaflets, a component of PAMSI, could work alongside these schemes by supporting pharmacy staff providing infection self-care and safety netting advice to patients on common infections. Of 2043 TARGET Antibiotic Checklists completed, patients’ reported knowledge was similar to that found in the feasibility study of PAMSI [ 20 ]; the lack of understanding of duration of infection and returning unused antibiotics to the pharmacy is common in the literature [ 20 , 25 , 30 ]. A 2020 public survey on infection health-seeking behaviours found high trust for pharmacists’ advice about the need for antibiotics, which has significantly improved since a previous survey in 2014 [ 13 ].…”

“…A 2020 public survey on infection health-seeking behaviours found high trust for pharmacists’ advice about the need for antibiotics, which has significantly improved since a previous survey in 2014 [ 13 ]. The public trust the advice of community pharmacy staff on common infections [ 28 , 30 ]; however, public campaigns should continue to encourage this, as in public surveys, ‘visiting a GP’ is still the most common source of health information [ 31 ]. Use of online health advice is increasing, particularly in younger age groups [ 31 ]; however, our findings suggest that pharmacy staff primarily provided advice verbally, and very few signposted to websites or apps; although this did improve in the post-intervention questionnaire, this is likely due to COVID-19 pandemic restrictions.…”

Co-Developing an Antibiotic Stewardship Tool for Dentistry: Shared Decision-Making for Adults with Toothache or Infection

“…Some patients in the ethnographic study exhibited well-developed negotiation/communication skills [ 11 ], and bargaining for antibiotics has also been identified in studies undertaken in medical contexts [ 36 , 37 ]. Empowering patients by supporting communication between patient and clinicians has been identified in NHS primary medical care as another potentially important way of reducing overprescribing of antibiotics [ 38 ]. By facilitating shared decision-making, it is anticipated that the worksheet developed will also help improve dentist-patient communication, which has been identified as a priority for oral and dental research in England [ 39 ].…”

Safety-netting in the consultation

“…In one observational study of recorded GP consultations (318 patients, 23 GPs), the most common condition patients were told to reconsult for was if their symptoms persisted, but often patients were not told how long they should wait. 11 Explaining the expected duration of symptoms, where known, can help empower patients to self care for their condition, 26 and help avoid early or delayed re-presentation.…”