GPs' views in five European countries of interventions to promote prudent antibiotic use

Tonkin‐Crine, Sarah; Yardley, Lucy; Coenen, Samuel; Fernandez-Vandellos, Patricia; Krawczyk, Jaroslaw; Touboul, P; Verheij, Theo; Little, Paul

doi:10.3399/bjgp11x572445

Cited by 45 publications

(35 citation statements)

References 30 publications

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“…28 GPs in five European countries mentioned patient demand for antibiotics as a driver for prescribing, and supported patient directed educational materials and public campaigns to reduce demand. 29 Antibiotic compliance in acute cough, recorded prospectively in patients from Cardiff and Southampton, was much lower (54% and 58%) 30 than the 75% of participants in this current study who reported finishing their antibiotic course. In contrast, an English telephone survey found that 90% of responders reported finishing their last course; 31 retrospective surveys may not be as reliable as the prospective study.…”

Section: Comparison With Existing Literaturementioning

confidence: 68%

Expectations for consultations and antibiotics for respiratory tract infection in primary care: the RTI clinical iceberg

Nichols²,

et al. 2013

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Section: Comparison With Existing Literaturementioning

confidence: 68%

Expectations for consultations and antibiotics for respiratory tract infection in primary care: the RTI clinical iceberg

Nichols²,

et al. 2013

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“…Previous international studies found that clinicians value POCTs as an intervention to help reduce unnecessary antibiotic prescribing. 18,19 However, these studies asked about hypothetical, rather than actual, use.…”

Section: Discussionmentioning

confidence: 99%

“…The STAR study evaluated a multifaceted educational intervention delivered through both online and outreach visit training, and was centred on communication skills. [16][17][18][19][20][21][22][23][24][25][26] Clinicians reported that communication skills training gave them an additional insight into their patients' agendas, which they felt would reduce future unnecessary consultations, but required an initial investment of longer consultations. The current study found that only a minority of clinicians specifically mentioned the advantage of the communication skills and most concentrated on the benefits of the patient booklet.…”

Section: Discussionmentioning

confidence: 99%

Clinicians’ Views and Experiences of Interventions to Enhance the Quality of Antibiotic Prescribing for Acute Respiratory Tract Infections

et al. 2014

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BACKGROUND: Evidence shows a high rate of unnecessary antibiotic prescriptions in primary care in Europe and the United States. Given the costs of widespread use and associated antibiotic resistance, reducing inappropriate use is a public health priority. OBJECTIVE: We aimed to explore clinicians' experiences of training in communication skills and use of a patient booklet and/or a C-reactive protein (CRP) point-of-care test to reduce antibiotic prescribing for acute respiratory tract infections (RTIs). DESIGN: We used a qualitative research approach, interviewing clinicians who participated in a randomised controlled trial (RCT) testing two contrasting interventions. PARTICIPANTS: General practice clinicians in Belgium, England, The Netherlands, Poland, Spain and Wales participated in the study. APPROACH: Sixty-six semi-structured interviews were transcribed verbatim, translated into English where necessary, and analysed using thematic and framework analysis. KEY RESULTS: Clinicians from all countries attributed benefits for themselves and their patients to using both interventions. Clinicians reported that the communication skills training and use of the patient booklet gave them greater confidence in addressing patient expectations for an antibiotic by providing answers to common questions and supporting the clinician's own explanations. Clinicians felt the booklet could be used for a variety of patients and for different types of infections. The CRP test was viewed as a tool to decrease diagnostic uncertainty, to support non-prescription decisions, and to reassure patients, but was only necessary when clinicians were uncertain about the need for antibiotics. CONCLUSION: Providing clinicians with training and support tools for use in practice was received positively and was valued by clinicians across countries. Interventions seemed to have influenced behaviour by increasing clinician knowledge about illness severity and prescribing, increasing confidence in making non-prescribing decisions when antibiotics were unnecessary, and enabling clinicians to anticipate positive outcomes when making such decisions. Addressing such determinants of behaviour change enabled interventions to be relevant for clinicians working across different contexts.

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“…Qualitative studies on antimicrobial prescribing paid less attention to specific groups of prescribers, such as doctors in training. [31][32][33] With social norms and informal influences increasingly recognised as important in antimicrobial prescribing, 34,35 uncertainty exists about which intervention types to implement for trainees and what refinements are needed for local circumstances. There is also less understanding of how antimicrobial prescribing interventions should be tailored to address the specific needs of doctors in training, as most studies assume that doctors are a uniform body of health professionals with similar needs.…”

Section: Future Researchmentioning

confidence: 99%

Interventions to improve antimicrobial prescribing of doctors in training (IMPACT): a realist review

Papoutsi

Mattick

Pearson

et al. 2018

Health Serv Deliv Res

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BackgroundInterventions to improve the antimicrobial prescribing practices of doctors have been implemented widely to curtail the emergence and spread of antimicrobial resistance, but have been met with varying levels of success.ObjectivesThis study aimed to generate an in-depth understanding of how antimicrobial prescribing interventions ‘work’ (or do not work) for doctors in training by taking into account the wider context in which prescribing decisions are enacted.DesignThe review followed a realist approach to evidence synthesis, which uses an interpretive, theory-driven analysis of qualitative, quantitative and mixed-methods data from relevant studies.SettingPrimary and secondary care.ParticipantsNot applicable.InterventionsStudies related to antimicrobial prescribing for doctors in training.Main outcome measuresNot applicable.Data sourcesEMBASE (via Ovid), MEDLINE (via Ovid), MEDLINE In-Process & Other Non-Indexed Citations (via Ovid), PsycINFO (via Ovid), Web of Science core collection limited to Science Citation Index Expanded (SCIE) and Conference Proceedings Citation Index – Science (CPCI-S) (via Thomson Reuters), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, the Health Technology Assessment (HTA) database (all via The Cochrane Library), Applied Social Sciences Index and Abstracts (ASSIA) (via ProQuest), Google Scholar (Google Inc., Mountain View, CA, USA) and expert recommendations.Review methodsClearly bounded searches of electronic databases were supplemented by citation tracking and grey literature. Following quality standards for realist reviews, the retrieved articles were systematically screened and iteratively analysed to develop theoretically driven explanations. A programme theory was produced with input from a stakeholder group consisting of practitioners and patient representatives.ResultsA total of 131 articles were included. The overarching programme theory developed from the analysis of these articles explains how and why doctors in training decide to passively comply with or actively follow (1) seniors’ prescribing habits, (2) the way seniors take into account prescribing aids and seek the views of other health professionals and (3) the way seniors negotiate patient expectations. The programme theory also explains what drives willingness or reluctance to ask questions about antimicrobial prescribing or to challenge the decisions made by seniors. The review outlines how these outcomes result from complex inter-relationships between the contexts of practice doctors in training are embedded in (hierarchical relationships, powerful prescribing norms, unclear roles and responsibilities, implicit expectations about knowledge levels and application in practice) and the mechanisms triggered in these contexts (fear of criticism and individual responsibility, reputation management, position in the clinical team and appearing competent). Drawing on these findings, we set out explicit recommendations for optimal tailoring, design and implementation of antimicrobial prescribing interventions targeted at doctors in training.LimitationsMost articles included in the review discussed hospital-based, rather than primary, care. In cases when few data were available to fully capture all the nuances between context, mechanisms and outcomes, we have been explicit about the strength of our arguments.ConclusionsThis review contributes to our understanding of how antimicrobial prescribing interventions for doctors in training can be better embedded in the hierarchical and interprofessional dynamics of different health-care settings.Future workMore work is required to understand how interprofessional support for doctors in training can contribute to appropriate prescribing in the context of hierarchical dynamics.Study registrationThis study is registered as PROSPERO CRD42015017802.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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GPs' views in five European countries of interventions to promote prudent antibiotic use

Cited by 45 publications

References 30 publications

Expectations for consultations and antibiotics for respiratory tract infection in primary care: the RTI clinical iceberg

Expectations for consultations and antibiotics for respiratory tract infection in primary care: the RTI clinical iceberg

Clinicians’ Views and Experiences of Interventions to Enhance the Quality of Antibiotic Prescribing for Acute Respiratory Tract Infections

Interventions to improve antimicrobial prescribing of doctors in training (IMPACT): a realist review

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