General Practitioners’ Views on the Acceptability and Applicability of Using Quality Indicators as an Intervention to Reduce Unnecessary Prescription of Antibiotics in Four South American Countries

Abstract

As part of the quality improvement program “Health Alliance for Prudent Prescribing, Yield And Use of anti-microbial Drugs In the Treatment of respiratory tract infections” (HAPPY AUDIT) South America, we planned to implement an intervention based on the use of quality indicators as a means to influence General Practitioners’ (GPs) prescribing decision. Knowledge on the acceptability and applicability of an intervention is crucial to decide whether the intervention is suitable and will achieve the expected outcomes. This study explores GPs’ views about the acceptability and applicability of using quality indicators as an intervention to influence their prescribing decision in patients with suspected Respiratory Tract Infections (RTIs) across four countries in South-America. In March 2015, GPs that were participating in HAPPY AUDIT South America were invited to participate in focus groups. A discussion guide covering the domains acceptability and applicability was used. Data was analyzed through systematic text condensation with an inductive approach. 171 GPs were invited and 48% participated. Acceptability ranged from totally acceptable to slightly acceptable. This spectrum of GPs views on acceptability was influenced by themes concerning applicability. In conclusion, there is a positive attitude towards the use of quality indicators. Nonetheless, applicability challenges have to be taken into consideration and solved if we are to achieve a large effect with the implementation of this intervention.

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

“…There are also planned activities in Botswana and Namibia to develop pertinent quality indicators for assessing the quality of prescribing of antibiotics in ambulatory care given concerns with the WHO/INRUD (International Network for the Rational Use of Drugs) indicators as well as concerns with the extent of prescribing of antibiotics for URTIs among private general practitioners in Botswana 180,232,270,271 . This builds on discussions of possible quality indicators to influence future prescribing of antibiotics in other LMICs 272 . Adherence to current guidelines is seen as a better predictor of the quality of prescribing of antibiotics than current WHO/ INRUD criteria 271 .…”

Overdiagnosis paradigm: not suitable for decreasing the overuse of antibiotics

“…Worldwide, the patient–doctor encounter in primary care faces similar challenges such as (a) short consultation time, (b) high uncertainty of the origin of the symptoms, (c) uncertainty of the evolution of symptoms and (d) organisational challenges for following the patient 9 10…”

“…Some clinicians do not feel that it is worth jeopardising their relationship with a patient or parent over a relatively minor matter of prescribing antibiotics. The consequences for the future relationship with patients are more of a concern for GPs prescribing antibiotics than antibiotic resistance 9. GPs are generally aware of and concerned about the threat that antimicrobial resistance poses and agree that this is a growing problem.…”

Antibiotic deprescribing: Spanish general practitioners’ views on a new strategy to reduce inappropriate use of antibiotics in primary care

“…Doctors consider it their priority to be responsive to the needs of the individual patient, viewing AMR as a public health issue. Some clinicians do not feel it is worth jeopardising their relationship with a patient over what they consider a relatively minor matter, prescribing antibiotics [ 20 ], or over concerns of AMR [ 21 ].…”