Over prescribing of antibiotics for acute respiratory tract infections; a qualitative study to explore Irish general practitioners’ perspectives

Abstract

Background Anti-microbial resistance (AMR) is a global threat to public health and antibiotics are often unnecessarily prescribed for acute respiratory tract infections (ARTIs) in general practice. We aimed to investigate why general practitioners (GPs) continue to prescribe antibiotics for ARTIs despite increasing knowledge of their poor efficacy and worsening antimicrobial resistance. Methods We used an explorative qualitative study design. Thirteen GPs were recruited through purposive sampling to represent urban and rural settings and years of experience. They were based in general practices within the Mid-West of Ireland. GPs took part in semi-structured interviews that were digitally audio recorded and transcribed. Results Three main themes and three subthemes were identified. Themes include (1) non-comprehensive guidelines; how guideline adherence can be difficult, (2) GPs under pressure; pressures to prescribe from patients and perceived patient expectations and (3) Unnecessary prescribing; how to address it and the potential of public interventions to reduce it. Conclusions GPs acknowledge their failure to implement guidelines because they feel they are less usable in clinical situations. GPs felt pressurised to prescribe, especially for fee-paying patients and in out of hours settings (OOH), suggesting the need for interventions that target the public’s perceptions of antibiotics. GPs behaviours surrounding prescribing antibiotics need to change in order to reduce AMR and change patients’ expectations. Electronic supplementary material The online version of this article (10.1186/s12875-019-0917-8) contains supplementary material, which is available to authorized users.

Primary care physicians’ attitudes and perceptions towards antibiotic resistance and outpatient antibiotic stewardship in the USA: a qualitative study

“…These findings are consistent with previous research on perceptions of drivers of outpatient antibiotic prescribing. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] In particular, the perception of patient demand as a driving force behind inappropriate prescribing practices continues to be a consistent finding across studies both in the USA and other countries. Similar perceptions have also been documented among inpatient physicians who believe that prescribers outside of hospitals are primarily responsible for antibiotic overuse and antibiotic resistance, underscoring the value for individual feedback on prescribing patterns to help these physicians recognise the need for antibiotic stewardship in their practice.…”

“…Many studies, including those from the USA and Europe, have shown that physicians consider patient demand and prescribing of other physicians to be primary drivers of inappropriate antibiotic prescribing. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] In order to counteract these drivers of inappropriate prescribing, physicians have highlighted a need for improved public education around antibiotic resistance and the need for appropriate prescribing. 20-23 26 Additionally, studies from USA and European countries have shown that physician time constraints, fear of undertreating patients due to diagnostic uncertainty, and certain clinical factors are also seen as drivers of inappropriate prescribing.…”

Autonomy, power dynamics and antibiotic use in primary healthcare: A qualitative study

“…Recent qualitative research on this area has explored service users' [32] and prescribers' [33][34][35][36][37] attitudes towards delayed antibiotic prescription, prescribers' attitudes and experiences on antibiotic prescribing [38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54], service users' experiences on antibiotic use [38,39,48,51,[55][56][57][58], self-care treatments for ALRTIs [32,59], service users' [48,60] and health professionals' [47,48] understandings of AMR and antibiotic use, interactions between health Committee of the Institut de Recerca en Atenció Primària Jordi Gol i Gurina (IDIAPJGol) (contact via cei@idiapjgol.info) for researchers who meet the criteria for access to confidential data. For more information on data availability restrictions you can contact the ethics committee at cei@idiapjgol.info.…”

“…Recent qualitative research on this area has explored service users’ [ 32 ] and prescribers’ [ 33 – 37 ] attitudes towards delayed antibiotic prescription, prescribers’ attitudes and experiences on antibiotic prescribing [ 38 – 54 ], service users’ experiences on antibiotic use [ 38 , 39 , 48 , 51 , 55 – 58 ], self-care treatments for ALRTIs [ 32 , 59 ], service users’ [ 48 , 60 ] and health professionals’ [ 47 , 48 ] understandings of AMR and antibiotic use, interactions between health professionals and service users [ 47 ], experiences of ALRTIs [ 59 ], the role of pharmaceutical companies on antibiotic overprescribing and AMR [ 39 ], and socio-cultural factors to promote adequate antibiotic use [ 61 ]. These studies are mostly focused on health professionals’ experiences (rather than service users’) and take a conventional biomedical perspective to health and AMR.…”

A cross-sectional research conducted in Malatya province, Turkey: Knowledge levels and awareness about rational antibiotic use and antimicrobial resistance before and after graduation

“…Today, unfortunately, physicians are able to allocate less than optimal time to the patients for diagnosis because of overcrowded patient to primary healthcare services, and are often under pressure to prescribe antibiotics by patients and/or their relatives (18).…”