scholarly journals Understanding doctors’ emergency department antibiotic prescribing decisions in children with respiratory symptoms in the UK: a qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e051561
Author(s):  
Thomas Hampton ◽  
Jane Ogden ◽  
Helen Mary Higgins
Keyword(s):  
Qualitative Study ◽  
Emergency Departments ◽  
Critical Incident ◽  
Respiratory Symptoms ◽  
Antibiotic Prescribing ◽  
External Pressures ◽  
Semistructured Interviews ◽  
Prescribing Practice ◽  
Hospital Doctors ◽  
The Uk

ObjectiveExploration of the factors that influence hospital doctors’ antibiotic prescribing decisions when treating children with respiratory symptoms in UK emergency departments.MethodsA qualitative study using semistructured interviews based on a critical incident technique with 21 physicians of different grades and specialties that treat children in the UK. Interviews were audio-recorded then transcribed verbatim and analysed using thematic analysis.ResultsFour themes were identified. These themes illustrate factors which influence clinician prescribing. The three principal themes were authorities, pressures and risk. The fourth transcending theme that ran through all themes was clinician awareness and complicity (‘knowing but still doing’).ConclusionsHospital doctors prescribe antibiotics even when they know they should not. This appears to be due to the influence of those in charge or external pressures experienced while weighing up the immediate and longer term risks but clinicians do this with full insight into their actions. These findings have implications for invested parties seeking to develop future antimicrobial stewardship programmes. It is recommended that stewardship interventions acknowledge and target these themes which may in turn facilitate behaviour change and antimicrobial prescribing practice in emergency departments.

scholarly journals Long COVID and the role of physical activity: a qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e047632
Author(s):  
Helen Humphreys ◽  
Laura Kilby ◽  
Nik Kudiersky ◽  
Robert Copeland
Keyword(s):  
Physical Activity ◽  
Qualitative Study ◽  
Lived Experience ◽  
Well Being ◽  
Telephone Interviews ◽  
Semistructured Interviews ◽  
The Usa ◽  
The Uk ◽  
Insight Into

ObjectivesTo explore the lived experience of long COVID with particular focus on the role of physical activity.DesignQualitative study using semistructured interviews.Participants18 people living with long COVID (9 men, 9 women; aged between 18–74 years; 10 white British, 3 white Other, 3 Asian, 1 black, 1 mixed ethnicity) recruited via a UK-based research interest database for people with long COVID.SettingTelephone interviews with 17 participants living in the UK and 1 participant living in the USA.ResultsFour themes were generated. Theme 1 describes how participants struggled with drastically reduced physical function, compounded by the cognitive and psychological effects of long COVID. Theme 2 highlights challenges associated with finding and interpreting advice about physical activity that was appropriately tailored. Theme 3 describes individual approaches to managing symptoms including fatigue and ‘brain fog’ while trying to resume and maintain activities of daily living and other forms of exercise. Theme 4 illustrates the battle with self-concept to accept reduced function (even temporarily) and the fear of permanent reduction in physical and cognitive ability.ConclusionsThis study provides insight into the challenges of managing physical activity alongside the extended symptoms associated with long COVID. Findings highlight the need for greater clarity and tailoring of physical activity-related advice for people with long COVID and improved support to resume activities important to individual well-being.

scholarly journals A qualitative study of patients’ feedback about Outpatient Parenteral Antimicrobial Therapy (OPAT) services in Northern England: implications for service improvement

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e019099 ◽  
Author(s):  
Maureen Twiddy ◽  
Carolyn J Czoski Murray ◽  
Samantha J Mason ◽  
David Meads ◽  
Judy M Wright ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Antimicrobial Therapy ◽  
Local Population ◽  
Health Centre ◽  
Service Improvement ◽  
Self Administration ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Semistructured Interviews ◽  
The Uk ◽  
At Home

ObjectiveOutpatient parenteral antimicrobial therapy (OPAT) provides opportunities for improved cost savings, but in the UK, implementation is patchy and a variety of service models are in use. The slow uptake in the UK and Europe is due to a number of clinical, financial and logistical issues, including concern about patient safety. The measurement of patient experience data is commonly used to inform commissioning decisions, but these focus on functional aspects of services and fail to examine the relational aspects of care. This qualitative study examines patients’ experiences of OPAT.DesignIn-depth, semistructured interviews.SettingPurposive sample of OPAT patients recruited from four acute National Health Service (NHS) Trusts in Northern England. These NHS Trusts between them represented both well-established and recently set-up services running nurse at home, hospital outpatient and/or self-administration models.ParticipantsWe undertook 28 semistructured interviews and one focus group (n=4).ResultsDespite good patient outcomes, experiences were coloured by patients' personal situation and material circumstances. Many found looking after themselves at home more difficult than they expected, while others continued to work despite their infection. Expensive car parking, late running services and the inconvenience of waiting in for the nurse to arrive frustrated patients, while efficient services, staffed by nurses with the specialist skills needed to manage intravenous treatment had the opposite effect. Many patients felt a local, general practitioner or community health centre based service would resolve many of the practical difficulties that made OPAT inconvenient. Patients could find OPAT anxiety provoking but this could be ameliorated by staff taking the time to reassure patients and provide tailored information.ConclusionServices configurations must accommodate the diversity of the local population. Poor communication can leave patients lacking the confidence needed to be a competent collaborator in their own care and affect their perceptions of the service.

Women’s experiences of self-referral to an abortion service: qualitative study

2020 ◽  
pp. bmjsrh-2019-200568
Author(s):  
Shin Thong Low ◽  
Zhong Eric Chen ◽  
Sharon Cameron
Keyword(s):  
Qualitative Study ◽  
Abortion Service ◽  
Referral Process ◽  
Phone Line ◽  
Women’S Experiences ◽  
Women's Experiences ◽  
Referral Service ◽  
Semistructured Interviews ◽  
The Uk ◽  
Levels Of Support

BackgroundGuidelines from the UK recommend that women should be able to self-refer to abortion services. In 2016, a self-referral system was introduced to the abortion service in Edinburgh, Scotland, as an option for women. Women could telephone a dedicated phone line during office hours and speak to an administrative assistant working in the abortion service who provided them the next available appointment to be seen in the service. This study aimed to evaluate a self-referral service to abortion by investigating its impact on women’s experiences of the referral process.Methodology21 semistructured interviews of women attending a specialist abortion service in Edinburgh, Scotland, were conducted. Interviews were transcribed verbatim and thematically analysed. The interviews focused on women’s experience of the referral process.ResultsThree main themes arose from the interviews, including reasons for choosing self-referral, experience of self-referral and challenges to using self-referral. Reasons for choosing self-referral were related to convenience, privacy and autonomy. Women found the experience of self-referral to be pleasant, non-judgemental and patient-centred, and self-referral prepared them for the appointment at the specialist abortion service. However, some women felt rushed, and self-referral made them anxious to attend the appointment. Challenges were difficulty with getting through on telephone lines, varying levels of support required for different individuals and awareness about the option of self-referral.ConclusionWomen valued the option of self-referral. Women felt that the service should be expanded to increase availability,and promoted to women more widely within the community .

scholarly journals Theory-based electronic learning intervention to support appropriate antibiotic prescribing by nurse and pharmacist independent prescribers: an acceptability and feasibility experimental study using mixed methods

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e036181 ◽  
Author(s):  
Rosemary Lim ◽  
Molly Courtenay ◽  
Rhian Deslandes ◽  
Rebecca Ferriday ◽  
David Gillespie ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Learning Activity ◽  
Antibiotic Prescribing ◽  
Slight Reduction ◽  
Electronic Learning ◽  
Learning Intervention ◽  
Semistructured Interviews ◽  
Before And After ◽  
The Uk ◽  
Tract Infections

ObjectivesTo assess the acceptability and feasibility of using a theory-based electronic learning intervention designed to support appropriate antibiotic prescribing by nurse and pharmacist independent prescribers for patients presenting with common, acute, uncomplicated self-limiting respiratory tract infections (RTIs).DesignExperimental with mixed methods; preintervention and postintervention online surveys and semistructured interviews.SettingPrimary care settings across the UK.Participants11 nurse and 4 pharmacist prescribers.InterventionA theory-based brief interactive animation electronic learning activity comprised a consultation scenario by a prescriber with an adult presenting with a common, acute, uncomplicated self-limiting RTI to support a ‘no antibiotic prescribing strategy’.Outcome measuresRecruitment, response and attrition rates were assessed. The overall usefulness of the intervention was assessed by analysing prescribers’ self-reported confidence and knowledge in treating patients with RTIs before and after undertaking the intervention, and views on the relevance of the intervention to their work. Acceptability of the intervention was assessed in semistructured interviews. The feasibility of data collection methods was assessed by recording the number of study components completed by prescribers.Results15 prescribers (maximum sample size) consented and completed all four stages of the study. Prescribers reported high to very high levels of confidence and knowledge preintervention and postintervention, with slight postintervention increases in communicating with patients and a slight reduction in building rapport. Qualitative findings supported quantitative findings; prescribers were reassured of their own practice which in turn increased their confidence and knowledge in consultations. The information in the intervention was not new to prescribers but was applicable and useful to consolidate learning and enable self-reflection. Completing the e-learning intervention was acceptable to prescribers.ConclusionsIt was feasible to conduct the study. The intervention was acceptable and useful to prescribers. Future work will add complex clinical content in the intervention before conducting a full trial.

scholarly journals Antibiotic usage and stewardship in patients with COVID-19: too much antibiotic in uncharted waters?

2020 ◽  
pp. 175717742097681
Author(s):  
Terry John Evans ◽  
Harriet Claire Davidson ◽  
Jen Mae Low ◽  
Marina Basarab ◽  
Amber Arnold
Keyword(s):  
Teaching Hospital ◽  
Antibiotic Consumption ◽  
Antibiotic Usage ◽  
Antibiotic Prescribing ◽  
National Guidelines ◽  
Definitive Evidence ◽  
Prescribing Practice ◽  
History Of ◽  
Medical Wards ◽  
The Uk

Background: Antimicrobial usage and stewardship programmes during COVID-19 have been poorly studied. Prescribing practice varies despite national guidelines, and there is concern that stewardship principles have suffered. Aim: To analyse antibiotic prescriptions during the COVID-19 pandemic at a teaching hospital and to propose improved approaches to stewardship. Methods: We reviewed COVID-19 admissions to medical wards and intensive care units (ICUs) in a London teaching hospital to assess initial antibiotic usage and evidence of bacterial co-infection, and to determine if our current antibiotic guidelines were adhered to. Findings: Data from 130 inpatients (76% medical and 24% ICU) were obtained. On admission, 90% were treated with antibiotics. No microbiological samples taken on admission provided definitive evidence of respiratory co-infection. In 13% of cases, antibiotics were escalated, usually without supporting clinical, radiological or laboratory evidence. In 16% of cases, antibiotics were stopped or de-escalated within 72 h. Blood results and chest radiographs were characteristic of COVID-19 in 20% of ward patients and 42% of ICU patients. Overall mortality was 25% at 14 days – similar to rates described for the UK as a whole. Conclusion: The majority of patients received antibiotics despite limited evidence of co-infection. Most patients received narrower spectrum antibiotics than recommended by NICE. As understanding of the natural history of COVID-19 infections progresses, stewardship programmes will need to evolve; however, at this point, we feel that a more restrictive antibiotic prescribing approach is warranted. We propose strategies for effective stewardship and estimate the effect this may have on antibiotic consumption.

scholarly journals Training in neurology: lessons learnt

2019 ◽  
Vol 19 (5) ◽  
pp. 431-437 ◽  
Author(s):  
Samuel Shribman ◽  
Sian K Alexander ◽  
Angelika Zarkali ◽  
Thomas T Warner ◽  
Anthony C Pereira ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Case Studies ◽  
Survey Data ◽  
Lessons Learnt ◽  
Semistructured Interviews ◽  
National Training ◽  
The Uk

There is no consensus on how to structure and deliver neurology training. The General Medical Council’s annual National Training Survey indicates that the quality of UK neurology training is very variable, but does not explain this variation. We used the survey data to identify the four highest and lowest performing sites for neurology training across the UK. We conducted semistructured interviews with groups of local trainees and, separately, local trainers in an exploratory qualitative study, and identified common themes across a range of aspects of neurology training. Here we present our findings, share case studies from top-performing sites and make recommendations on how best to train a neurologist.

scholarly journals Morita Therapy for depression (Morita Trial): an embedded qualitative study of acceptability

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e023873
Author(s):  
Holly Victoria Rose Sugg ◽  
Julia Frost ◽  
David A Richards
Keyword(s):  
Qualitative Study ◽  
Large Scale ◽  
Controlled Trial ◽  
Future Research ◽  
Treatment As Usual ◽  
Morita Therapy ◽  
Semistructured Interviews ◽  
Framework Approach ◽  
Randomised Controlled ◽  
The Uk

ObjectiveTo explore the views of UK-based recipients of Morita Therapy (MT) on the acceptability of MT.DesignQualitative study nested within a pilot randomised controlled trial of MT (a Japanese psychological therapy largely unknown in the UK) versus treatment as usual, using post-treatment semistructured interviews analysed with a framework approach.Setting and participantsParticipants who received MT as part of the Morita Trial, recruited for the trial from General Practice record searches in Devon, UK. Data from 16 participants were purposively sampled for analysis.ResultsWe identified five themes which, together, form a model of how different participants viewed and experienced MT. Overall, MT was perceived as acceptable by many participants who emphasised the value of the approach, often in comparison to other treatments they had tried. These participants highlighted how accepting and allowing difficulties as natural phenomena and shifting attention from symptoms to external factors had facilitated symptom reduction and a sense of empowerment. We found that how participants understood and related to the principles of MT, in light of their expectations of treatment, was significantly tied to the extent to which MT was perceived as acceptable. Our findings also highlighted the distinction between MT in principle and practice, with participants noting challenges of engaging with the process of therapy such as fear and discomfort around rest, needing sufficient support from the therapist and others, and the commitment of treatment.ConclusionsPeople in the UK can accept the premise of MT, and consider the approach beneficial and novel. Therefore, proceeding to a large-scale trial of MT is appropriate with minor modifications to our clinical protocol. Participants’ expectations and understandings of treatment play a key role in acceptability, and future research may investigate these potential moderators of acceptability in MT.Trial registration numberCISRCTN17544090; Pre-results.

scholarly journals Should GPs have direct access to imaging for headache? A qualitative study of patients’ views in the UK

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e029376
Author(s):  
Alison McKinlay ◽  
Raphael Underwood ◽  
Gabriella Wojewodka ◽  
Asif Mazumder ◽  
Rachael Kilner ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Wait Time ◽  
Direct Access ◽  
Spontaneous Reduction ◽  
Imaging Results ◽  
Semistructured Interviews ◽  
Headache Clinic ◽  
The Uk ◽  
To Receive ◽  
Reporting Procedures

ObjectiveWe aimed to describe patients’ views of a new referral pathway of general practitioner (GP) direct access to MRI, versus imaging after referral to a specialist.DesignThis qualitative study involved 20 semistructured interviews. Twenty patients (10 from each pathway) were purposively recruited and interviewed to describe their attitudes.SettingA neurology headache clinic and neuroradiology services from the boroughs of Southwark and Lambeth in South London, UK.ParticipantsTwenty patients were involved in this study.ResultsOver half of the participants felt relieved once they received their scan results, while some remained uncertain about the underlying cause of their symptoms. Some participants described a long wait to see a specialist. Others described a long wait time to receive scan results, especially from their GP. Spontaneous reduction in headache symptoms occurred for some participants and for others, normal imaging results allowed them to focus more on symptom management.ConclusionRelief was reported especially when scan results had been explained clearly and without too much delay. Those with continuing pain focused on how to get relief from symptoms. Patient experience might be improved with clearer information from GPs about how patients can access results, standard reporting procedures and closer liaison between neuroradiology and GPs.

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