Understanding the delayed prescribing of antibiotics for respiratory tract infection in primary care: a qualitative analysis

Abstract

ObjectiveTo identify general practitioner (GP) views and understanding on the use of delayed prescribing in primary care.DesignQualitative semistructured telephone interview study.SettingPrimary care general practices in England.Participants32 GPs from identified high-prescribing and low-prescribing general practices in England.MethodSemistructured telephone interviews were conducted with GPs identified from practices within clinical commissioning groups with the highest and lowest prescribing rates in England. A thematic analysis of the data was conducted to generate themes.ResultsAll GPs had a good understanding of respiratory tract infection (RTI) management and how the delayed prescribing approach could be used in primary care. However, GPs highlighted factors that were influential as to whether delayed prescribing was successfully carried out during the consultation. These included the increase in evidence of antimicrobial resistance, and GPs' prior experiences of using delayed prescribing during the consultation. The patient–practitioner relationship could also influence treatment outcomes for RTI, and a lack of an agreed prescribing strategy within and between practices was considered to be of significance to GPs. Participants expressed that a lack of feedback on prescribing data at an individual and practice level made it difficult to know if delayed prescribing strategies were successful in reducing unnecessary consumption. GPs agreed that coherent and uniform training and guidelines would be of some benefit to ensure consistent prescribing throughout the UK.ConclusionsDelayed prescribing is encouraged in primary care, but is not always implemented successfully. Greater uniformity within and between practices in the UK is needed to operationalise delayed prescribing, as well as providing feedback on the uptake of antibiotics. Finally, GPs may need further guidance on how to answer the concerns of patients without interpreting these questions as a demand for antibiotics, as well as educating the patient about antimicrobial resistance and supporting a good patient–practitioner relationship.

Assessing the public acceptability of proposed policy interventions to reduce the misuse of antibiotics in Australia: A report on two community juries

“…A recent cross‐sectional survey of 730 GPs indicates that Australian practitioners perform well when their knowledge of antibiotic resistance is assessed, but despite this almost 40% of respondents admitted that they prescribe antibiotics to meet patient expectations . Although there is increasing enthusiasm for delayed prescribing among Australian GPs and health researchers, the low priority placed on this measure by both juries is consistent with other studies that indicates its broader acceptance will require significant efforts by GPs to build trust and public education to highlight the need for a larger community‐oriented response to “save” antibiotics for those who really need them …”

Symptom profile of patients receiving antibiotics for upper respiratory tract infections in general practice: an observational study using smartphone technology

“…(18) Others view delayed prescribing as an unnecessary compromise to meet patient expectation or allay patient fears when no prescription is the preferred alternative. (19) The lack of consistent guidelines for implementation of delayed prescribing also limits uptake. (9,19) Effective management of the consultation is a key consideration.…”

Physician prescription practice of antibiotics for upper respiratory tract infection at Kilimanjaro Christian Medical Centre Moshi, Tanzania

“…Additionally, Tanzanian Ministry of Health, Community Development, Gender, Seniors and Children should consider adopting a strategy of delayed prescription or delayed antibiotic use, which has shown to be effective in reducing antibiotic usage for URTIs (Spurling et al, 2013;Ryves et al, 2016). In a Cochrane Review it has been highlighted that delayed prescribing may be a suitable compromise in place of immediate prescribing to significantly reduce unnecessary antibiotic use and thereby reduce antibiotic resistance while maintaining patient safety and satisfaction levels (Spurling et al, 2017).…”