Influence of patient symptoms and physical findings on general practitioners' treatment of respiratory tract infections: a direct observation study

Background: The objective of the study was to assess the awareness of P- drug selection among rural general practitioners’s (GP) for common medical conditions.Methods: Fifty general practitioners in Tumakuru district were provided with proformas for selection of P- drugs for mild to moderate hypertension, diabetes, upper respiratory tract infections and acid peptic disease based on safety, affordability, need, and efficacy (SANE criteria).Results: Forty one GP’s responded by completing the proformas. Seventeen of them were aware of the concept of P- drug selection. In hypertension, beta blockers followed by Angiotensin Converting Enzyme (ACE) inhibitors were most commonly preferred. In diabetes, biguanides followed by sulfonylureas were preferred as oral hypoglycemic agents. Ampicillin, Ciprofloxacin and Cotrimoxazole were the commonly used antibiotics for upper respiratory tract infections. Ranitidine and antacids were preferred for acid peptic disease. Affordability followed by efficacy was the deciding criteria for P- drug selection.Conclusions: There is lack of awareness of P- drug selection among many rural GP’s. Therefore, there is necessity to create awareness about P- drug selection through continued medical education for rational use of drugs.

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General practitioners’ knowledge, attitude and prescribing of antibiotics for upper respiratory tract infections in Selangor, Malaysia: findings and implications

Expert Review of Anti-infective Therapy ◽

10.1586/14787210.2015.1012497 ◽

2015 ◽

pp. 1-10 ◽

Cited By ~ 6

Author(s):

Mohamed Azmi Hassali ◽

Tengku Karmila Tengku Kamil ◽

Faridah Aryani Md Yusof ◽

Alian A Alrasheedy ◽

Zuraidah Mohd Yusoff ◽

...

Keyword(s):

Respiratory Tract ◽

General Practitioners ◽

Respiratory Tract Infections ◽

Upper Respiratory Tract Infections ◽

Upper Respiratory Tract ◽

Upper Respiratory ◽

Tract Infections

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Antibiotic Prescribing and Doctor-Patient Communication During Consultations for Respiratory Tract Infections: A Video Observation Study in Out-of-Hours Primary Care

Frontiers in Medicine ◽

10.3389/fmed.2021.735276 ◽

2021 ◽

Vol 8 ◽

Author(s):

Annelies Colliers ◽

Katrien Bombeke ◽

Hilde Philips ◽

Roy Remmen ◽

Samuel Coenen ◽

...

Keyword(s):

Primary Care ◽

Respiratory Tract ◽

General Practitioners ◽

Communication Skills ◽

Respiratory Tract Infections ◽

Patient Expectations ◽

Antibiotic Prescribing ◽

Out Of Hours ◽

Doctor Patient Communication ◽

Tract Infections

Objective: Communication skills can reduce inappropriate antibiotic prescribing, which could help to tackle antibiotic resistance. General practitioners often overestimate patient expectations for an antibiotic. In this study, we describe how general practitioners and patients with respiratory tract infections (RTI) communicate about their problem, including the reason for encounter and ideas, concerns, and expectations (ICE), and how this relates to (non-)antibiotic prescribing in out-of-hours (OOH) primary care.Methods: A qualitative descriptive framework analysis of video-recorded consultations during OOH primary care focusing on doctor-patient communication.Results: We analyzed 77 videos from 19 general practitioners. General practitioners using patient-centered communication skills received more information on the perspective of the patients on the illness period. For some patients, the reason for the encounter was motivated by their belief that a general practitioner (GP) visit will alter the course of their illness. The ideas, concerns, and expectations often remained implicit, but the concerns were expressed by the choice of words, tone of voice, repetition of words, etc. Delayed prescribing was sometimes used to respond to implicit patient expectations for an antibiotic. Patients accepted a non-antibiotic management plan well.Conclusion: Not addressing the ICE of patients, or their reason to consult the GP OOH, could drive assumptions about patient expectations for antibiotics early on and antibiotic prescribing later in the consultation.

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Antibiotic prescribing for acute, non-complicated infections in primary care in Germany: baseline assessment in the cluster randomized trial ARena

BMC Infectious Diseases ◽

10.1186/s12879-021-06571-0 ◽

2021 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Regina Poss-Doering ◽

Dorothea Kronsteiner ◽

Martina Kamradt ◽

Edith Andres ◽

Petra Kaufmann-Kolle ◽

...

Keyword(s):

Primary Care ◽

Antimicrobial Resistance ◽

Respiratory Tract ◽

General Practitioners ◽

Respiratory Tract Infections ◽

Reference Group ◽

Antibiotic Prescribing ◽

Tract Infections ◽

Rational Use Of Antibiotics ◽

To Receive

Abstract Background Antimicrobial resistance is fueled by inappropriate use of antibiotics. Global and national strategies support rational use of antibiotics to retain treatment options and reduce resistance. In Germany, the ARena project (Sustainable reduction of antibiotic-induced antimicrobial resistance) intended to promote rational use of antibiotics for acute non-complicated infections by addressing network-affiliated physicians, primary care teams and patients through multiple interacting interventions. The present study documented patterns of antibiotic prescribing for patients with acute non-complicated infections who consulted a physician in these networks at the start of the ARena project. It explored variation across subgroups of patients and draws comparisons to prescribing patterns of non-targeted physicians. Methods This retrospective cross-sectional analysis used mixed logistic regression models to explore factors associated with the primary outcome, which was the percentage of patient cases with acute non-complicated respiratory tract infections consulting primary care practices who were treated with antibiotics. Secondary outcomes concerned the prescribing of different types of antibiotics. Descriptive methods were used to summarize the data referring to targeted physicians in primary care networks, non-targeted physicians (reference group), and patient subgroups. Results Overall, antibiotic prescribing rates were 32.0% in primary care networks and 31.7% in the reference group. General practitioners prescribed antibiotics more frequently than other medical specialist groups (otolaryngologists vs. General practitioners OR = 0.465 CI = [0.302; 0.719], p < 0.001, pediatricians vs. General practitioners: OR = 0.369 CI = [0.135; 1.011], p = 0.053). Quinolone prescribing rates were 9.9% in primary care networks and 8.1% in reference group. Patients with comorbidities had a higher likelihood of receiving an antibiotic and quinolone prescription and were less likely to receive a guideline-recommended substance. Younger patients were less likely to receive antibiotics (OR = 0.771 CI = [0.636; 0.933], p = 0.008). Female gender was more likely to receive an antibiotic prescription (OR = 1.293 CI = [1.201, 1.392], p < 0.001). Conclusion This study provided an overview of observed antibiotic prescribing for acute non-complicated respiratory tract infections in German primary care at the start of the ARena project. Findings indicate potential for improvement and will serve as comparator for the post-interventional outcome evaluation to facilitate describing of potential changes.

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