Understanding GPs’ views and experiences of using clinical prediction rules in the management of respiratory infections: a qualitative study

Abstract

Background:Respiratory tract infections (RTIs) account for 60% of antibiotic prescribing in primary care. Several clinical prediction rules (CPRs) have been developed to help reduce unnecessary prescribing for RTIs, but there are a lack of studies exploring whether or how these CPRs are being used in UK general practice.Aim:To explore UK GPs’ views and experiences with regards to RTI CPRs and to identify barriers and facilitators to their use in practice.Design & setting:A qualitative analysis of interviews with in-hours GPs working in the South and South West of England.Method:Semi-structured qualitative telephone interviews were conducted, digitally recorded, transcribed verbatim and analysed using an inductive thematic approach. Patient and public involvement representatives contributed to study design and interpretation of findings.Results:Thirty-two GPs were interviewed. Some CPRs were more commonly used than others. Participants used CPRs to facilitate patient-clinician discussion, confirm and support their decision, and document the consultation. GPs also highlighted concerns including lack of time, inability of CPRs to incorporate patient complexity, a shift in focus from the patient during consultations, and limited use in remote consultation (during the COVID-19 pandemic).Conclusion:This study highlights the need for user-friendly CPRs that are readily integrated into computer systems, and easily embedded into routine practice to complement clinical decision making. Existing CPRs need to be validated for other populations where demographics and clinical characteristics may differ as well different settings including remote consultations and self-assessment.

Improving healthcare professionals’ interactions with patients to tackle antimicrobial resistance: a systematic review of interventions, barriers, and facilitators

“…Some were established strategies, such as Treat Antibiotics Responsibly; Guidance, Education (TARGET) ( 28 , 41 , 53 ), antibiotics review kit (ARK) ( 37 ), Health Alliance for Prudent Prescribing, Yield and Use of Antimicrobial Drugs in the Treatment of Respiratory Tract Infections (HAPPY AUDIT) ( 60 , 61 ), Genomics to combat Resistance against Antibiotics in Community-acquired LRTI in Europe Internet TRaining for antibiOtic use (GRACE INTRO) ( 27 , 81 ) and Converting Habits of Antibiotic Use for Respiratory Tract Infections in German Primary Care (CHANGE-3) ( 72 , 74 ), while some were bespoke antimicrobial stewardship programmes ( 23 , 26 , 30 , 34 , 35 , 38 , 42 , 46 , 47 , 49 , 52 , 58 , 59 , 62–66 , 68 , 69 , 77–80 ). C-reactive protein point-of-care testing was often reported ( 26 , 27 , 33 , 34 , 40 , 50 , 51 , 56–59 , 70 , 76 , 81 ). The majority of the studies ( n = 51) reported that interventions include a patient interactive component in the form of posters, leaflet, videos, interactive decision support tools ( Table 1 ; Appendix 4 ).…”

“…A study among HCPs in paediatric emergency department in Canada reported that participants were unaware of their prescribing pattern and the scale and scope of the challenge of implementing antimicrobial stewardship in the emergency department ( 36 ). HCPs’ lack of awareness of the available interventions were also described ( 50 , 53 , 63 , 72 , 74 , 76 , 77 ). For example, many general practitioners in the United Kingdom were not aware of the Royal College of General Practitioners (RCGP) TARGET online courses and so they have not used them ( 53 ).…”

“…However, there were concerns that sometimes the clinician’s treatment plan and the booklet messages differ which would create confusion ( 43 ). Computer based prompts and clinical prediction rules were highlighted to be particularly useful for less experienced staff who may not be very familiar with guidelines ( 50 , 63 ). Many HCPs reported that resources such as clinical prediction rules and CRP point-of care testing helped them to manage patients’ expectation by providing evidence as to whether or not antibiotics are required, providing an objective measure to support judgement, reducing diagnostic uncertainties, supporting shared decision making and facilitating patient education around antibiotics ( 27 , 29 , 40 , 44 , 50 , 51 , 63 , 73 , 76 ).…”

“…However, HCPs do not always use the tools. For example, some participants in studies from Germany and United Kingdom noted that their professional experience influences their decisions more than the guideline recommendation and clinical prediction rules ( 50 , 73 ). Studies across United Kingdom and United States reported some participants feel that interventions, such as CRP testing, impact on the workflow and workload ( 23 , 44 , 51 ).…”

“…Lack of time was a major issue as HCPs have limited time with patients and utilising the interventions often adds to the time pressure ( 23 , 27–29 , 36 , 40 , 41 , 44 , 45 , 50 , 51 , 53 , 63 , 72 , 74 , 76 ). Some clinicians in a study in Germany used delayed prescription due to diagnostic uncertainty or when the potential for follow-up visits was limited, such as planned vacations, public holidays ( 73 ).…”