scholarly journals Antibiotic prescription in primary care from the perspective of family physicians: a qualitative study

2020 ◽  
Author(s):  
Salih Hosoglu ◽  
Annika Yanina Claßen
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Qualitative Study ◽  
Social Status ◽  
Antibiotic Prescription ◽  
Family Physicians ◽  
Antibiotic Use ◽  
Patient Expectations ◽  
Medical Decision ◽  
The Social

Abstract Background Antibiotic consumption rates increase worldwide steadily. Turkey is now top on the list of global consumption and a prototype of excessive use of antibiotics. In the last two-decades, family physicians (FPs) have become key figures in the healthcare system. The aim of this study is to understand the reasons for inappropriate prescription and to elicit suggestions for ways of improving antibiotic use in primary care from doctors themselves.Methods This is a qualitative study using semi-structured interviews with key individuals. Fourteen FPs from different parts of Turkey participated in these interviews. They were questioned on major indications for antibiotic prescription, reasons for inappropriate antibiotic prescription, obstacles to decision making in antibiotic use and their suggestions for improving antibiotic use. The interviews were recorded, transcribed, and analyzed for common themes. Thematic coding was used in the formulation of themes.Results Interviewees emphasized the coercive factors that lead to inappropriate antibiotic prescription: patient expectations, defensive medical decision making, constraints due to workload and limited access to laboratories. The most powerful suggestions for improving the quality of antibiotic prescription were public campaigns, improvements in the diagnostic infrastructures of primary care centers and enhancing the social status of FPs. The FPs expressed strong concerns related to the complaints that patients make to administrative bodies. Conclusions Physicians in primary care work under immense pressure stemming mainly from workload, patient expectations and obstacles to diagnostic processes. Improving the social status of physicians, increasing public awareness and the facilitation of diagnostic procedures were the methods suggested for increasing antibiotic prescription accuracy.

scholarly journals Antibiotic prescription in primary care from the perspective of family physicians: a qualitative study

2021 ◽  
Vol 15 (08) ◽  
pp. 1117-1123
Author(s):  
Salih Hosoglu ◽  
Annika Yanina Classen ◽  
Zekeriya Akturk
Keyword(s):  
Primary Care ◽  
Social Status ◽  
Antibiotic Prescription ◽  
Public Awareness ◽  
Family Physicians ◽  
Antibiotic Use ◽  
Patient Expectations ◽  
Medical Decision ◽  
Antibiotic Prescribing ◽  
The Social

Introduction: Antibiotic consumption increases worldwide steadily. Turkey is now top on the list of global consumption and became a prototype of excessive use of antibiotics. In the last two decades, family physicians (FPs) have become key figures in the healthcare system. This study aims to understand the reasons for inappropriate antibiotic prescribing and elicit suggestions for improving antibiotic use in primary care from doctors themselves. Methodology: This is a qualitative semi-structured interview study with research dialogues guided by the Vancouver School of interpretive phenomenology. Fourteen FPs from different parts of Turkey were questioned on inappropriate antibiotic prescriptions and their suggestions for improving antibiotic use. Results: The most important reasons for prescribing antibiotics without acceptable indications were patient expectations, defensive medical decision making, constraints due to workload, and limited access to laboratories. The most remarkable inference was the personal feeling of an insecure job environment of the FPs. The most potent suggestions for improving the quality of antibiotic prescription were public campaigns, improvements in the diagnostic infrastructures of primary care centers, and enhancing the social status of FPs. The FPs expressed strong concerns related to the complaints that patients make to administrative bodies. Conclusions: Primary care physicians work under immense pressure, stemming mainly from workload, patient expectations, and obstacles related to diagnostic processes. Improving the social status of physicians, increasing public awareness, and the facilitation of diagnostic procedures was the methods suggested for increasing antibiotic prescription accuracy.

scholarly journals Implementation of C-reactive protein point of care testing to improve antibiotic targeting in respiratory illness in Vietnamese primary care (ICAT): a study protocol for a cluster randomised controlled trial

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e040977
Author(s):  
Nga Thi Thuy Do ◽  
Rachel Claire Greer ◽  
Yoel Lubell ◽  
Sabine Dittrich ◽  
Maida Vandendorpe ◽  
...  
Keyword(s):  
Primary Care ◽  
Antibiotic Prescription ◽  
Point Of Care ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Antibiotic Use ◽  
Routine Care ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Randomised Controlled

IntroductionC-reactive protein (CRP), a biomarker of infection, has been used widely in high-income settings to guide antibiotic treatment in patients presenting with respiratory illnesses in primary care. Recent trials in low- and middle-income countries showed that CRP testing could safely reduce antibiotic use in patients with non-severe acute respiratory infections (ARIs) and fever in primary care. The studies, however, were conducted in a research-oriented context, with research staff closely monitoring healthcare behaviour thus potentially influencing healthcare workers’ prescribing practices. For policy-makers to consider wide-scale roll-out, a pragmatic implementation study of the impact of CRP point of care (POC) testing in routine care is needed.Methods and analysisA pragmatic, cluster-randomised controlled trial, with two study arms, consisting of 24 commune health centres (CHC) in the intervention arm (provision of CRP tests with additional healthcare worker guidance) and 24 facilities acting as controls (routine care). Comparison between the treatment arms will be through logistic regression, with the treatment assignment as a fixed effect, and the CHC as a random effect. With 48 clusters, an average of 10 consultations per facility per week will result in approximately 520 over 1 year, and 24 960 in total (12 480 per arm). We will be able to detect a reduction of 12% to 23% or more in immediate antibiotic prescription as a result of the CRP POC intervention. The primary endpoint is the proportion of patient consultations for ARI resulting in immediate antibiotic prescription. Secondary endpoints include the proportion of all patients receiving an antibiotic prescription regardless of ARI diagnosis, frequency of re-consultation, subsequent antibiotic use when antibiotics are not prescribed, referral and hospitalisation.Ethics and disseminationThe study protocol was approved by the Oxford University Tropical Research Ethics Committee (OxTREC, Reference: 53–18), and the ethical committee of the National Hospital for Tropical Diseases in Vietnam (Reference:07/HDDD-NDTW/2019). Results from this study will be disseminated via meetings with stakeholders, conferences and publications in peer-reviewed journals. Authorship and reporting of this work will follow international guidelines.Trial registration detailsNCT03855215; Pre-results.

How can Primary Care Physicians Best Support Contraceptive Decision Making? A Qualitative Study Exploring the Perspectives of Baltimore Latinas

2017 ◽  
Vol 27 (2) ◽  
pp. 158-166 ◽  
Author(s):  
Diana N. Carvajal ◽  
Deborah Gioia ◽  
Estefania Rivera Mudafort ◽  
Pamela Bohrer Brown ◽  
Beth Barnet
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Qualitative Study ◽  
Primary Care Physicians

Decision-Making about PSA Testing and Prostate Biopsies: A Qualitative Study Embedded in a Primary Care Randomised Trial

2008 ◽  
Vol 53 (6) ◽  
pp. 1186-1193 ◽  
Author(s):  
Kerry N.L. Avery ◽  
Jane M. Blazeby ◽  
J. Athene Lane ◽  
David E. Neal ◽  
Freddie C. Hamdy ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Qualitative Study ◽  
Randomised Trial ◽  
Prostate Biopsies ◽  
Psa Testing

scholarly journals How to decide adequately? Qualitative study of GPs’ view on decision-making in self-referred and physician-referred emergency department consultations in Berlin, Germany

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e026786 ◽  
Author(s):  
Sarah Oslislo ◽  
Christoph Heintze ◽  
Martina Schmiedhofer ◽  
Martin Möckel ◽  
Liane Schenk ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Qualitative Study ◽  
Qualitative Content Analysis ◽  
Wide Spectrum ◽  
Influencing Factor ◽  
Primary Care Providers ◽  
Ambulatory Setting ◽  
Care Providers ◽  
Registration Number

ObjectivesPatients with acute symptoms present not only to general practitioners (GPs), but also frequently to emergency departments (EDs). Patients’ decision processes leading up to an ED self-referral are complex and supposed to result from a multitude of determinants. While they are key providers in primary care, little is known about GPs’ perception of such patients. This qualitative study explores the GPs’ view regarding motives and competences of patients self-referring to EDs, and also GPs’ rationale for or against physician-initiated ED referrals.DesignQualitative study with semi-structured, face-to-face interviews; qualitative content analysis.SettingGP practices in Berlin, Germany.Participants15 GPs (female/male: 9/6; mean age 53.6 years).ResultsThe interviewed GPs related a wide spectrum of factors potentially influencing their patients’ decision to visit an ED, and also their own decision-making in potential referrals. Considerations go beyond medical urgency. Statements concerning patients’ surmised rationale corresponded to GPs’ reasoning in a variety of important areas. For one thing, the timely availability of an extended spectrum of diagnostic and therapeutic options may make ED services attractive to both. Access difficulties in the ambulatory setting were mentioned as additional triggers for an ED visit initiated by a patient or a GP. Key patient factors like severity of symptoms and anxiety also play a major role; a desire for reassurance may lead to both self-referred and physician-initiated ED visits. Patients’ health competence was prevailingly depicted as limited, with the internet as an important influencing factor. Counselling efforts by GP were described as crucial for improving health literacy.ConclusionsHealth education could hold promise when aiming to reduce non-urgent ED consultations. Primary care providers are in a key position here. Amelioration of organisational shortages in ambulatory care, for example, limited consultation hours, might also make an important impact, as these trigger both self-referrals and GP-initiated ED referrals.Trial registration numberDRKS00011930.

Is patient involvement possible when decisions involve scarce resources? A qualitative study of decision-making in primary care

2004 ◽  
Vol 59 (1) ◽  
pp. 93-102 ◽  
Author(s):  
Ian Rees Jones ◽  
Lee Berney ◽  
Moira Kelly ◽  
Len Doyal ◽  
Chris Griffiths ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Qualitative Study ◽  
Patient Involvement ◽  
Scarce Resources

scholarly journals Outpatient Antibiotic Use for Common Infectious Diagnoses: Patterns in Telehealth During the Emergence of COVID-19

2021 ◽  
Vol 1 (S1) ◽  
pp. s35-s36
Author(s):  
Brigid Wilson ◽  
Taissa Bej ◽  
Sunah Song ◽  
Janet M Briggs ◽  
Richard Banks ◽  
...  
Keyword(s):  
Primary Care ◽  
Healthcare System ◽  
Acute Respiratory Infection ◽  
Antibiotic Prescription ◽  
Antibiotic Use ◽  
Outpatient Clinics ◽  
Administrative Databases ◽  
Community Based ◽  
Outpatient Visits ◽  
Outpatient Settings

Background: The influence of increased use of telehealth during the emergence of COVID-19 on antibiotic prescriptions in outpatient settings is unknown. The VA Northeast Ohio Healthcare System has 13 community-based outpatient clinics (CBOCs) that provide primary and preventive care. We assessed changes in antibiotic prescriptions that occurred as care shifted from in-person to telehealth visits. Methods: Using VHA administrative databases, we identified all primary care CBOC visits between January 1, 2019, and December 31, 2020, that included a diagnosis for an acute respiratory infection (ARI), a urinary tract infection (UTI), or a skin or soft-tissue infection (SSTI), excluding visits with >1 of these diagnoses or with additional infectious diagnoses (eg, pneumonia, influenza). We summarized the proportion of telehealth visits and the proportion of patients prescribed antibiotics at quarterly intervals. We specifically assessed outpatient visits from April to December 2019 compared to the same months in 2020 to account for seasonality while analyzing diagnosis and antibiotic trends in the emergence of the COVID-19 pandemic. Results: The patients receiving care in April–December 2019 compared to April–December 2020 were similar (Table 1). From April through December 2019, 90% of CBOC primary care visits with a diagnosis for ARI, UTI, or SSTI were in-person, and antibiotics were prescribed at 63%, 46%, and 65% of visits in either modality, respectively (Figure 1). From April through December 2020, only 33% of CBOC primary care visits for ARI, UTI, and SSTI were in person, and antibiotics were prescribed at 46%, 38%, and 47% of visits in either modality, respectively. Comparing April–December in 2019 and 2020, the number of CBOC visits for ARI fell by 76% (2,152 visits to 509 visits), with a more modest decline of 20% and 35% observed for UTI and SSTI visits. In-person visits for ARIs and SSTIs were more likely than telehealth visits to result in an antibiotic prescription (Figure 2). Conclusions: Among the CBOCs at our healthcare system, an increase in the proportion of telehealth visits and a reduction in ARI diagnoses occurred after the emergence of COVID-19. In this setting, we observed a reduction in the proportion of visits for ARIs, UTIs, and SSTIs that included an antibiotic prescription.Funding: MerckDisclosures: None

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