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Pharmacy World & Science

, Volume 32, Issue 6, pp 805–814 | Cite as

Diagnosing infections: a qualitative view on prescription decisions in general practice over time

  • Ingunn BjörnsdóttirEmail author
  • Karl G. Kristinsson
  • Ebba Holme Hansen
Research Article

Abstract

Objective Antibiotics may frequently be prescribed on the basis of vague diagnoses, possibly resulting in unnecessary antimicrobial resistance. Our aim is to map general practitioners’ (GPs’) decision-making for common infections, exploring their diagnostic basis for antibiotic prescriptions. Setting General practice in Iceland. Method Ten in-depth qualitative interviews with, and three observations of, GPs in 1995. Diagnostic issues extracted and analysed. In 2006, eight GPs commented on analysis and updated (email/telephone). Main outcome measure Diagnostic variability and reasons for prescribing antibiotics, consistency or changes over time. Results Wide variations were uncovered in diagnostic procedures, although each GP remained consistent through time. Some GPs had developed “rules-of-thumb”. They often balanced risks against issues like money, time, need for the workforce (perceived importance of the patient’s job), client’s need for job/earnings (perceived ability to afford a sick day) and doctor-patient relationship (risk of refusal adversely affecting the relationship). Perceptions of risk varied from focusing on resistance development to focusing on possible harm from untreated infections, also ranging between considering both to worrying about neither. Changes over time were not prominent but included increased point-of-care testing and the perception by GPs that patients were increasingly willing to “wait and see”. Conclusions Large variability and individuality characterized the GPs’ diagnostic procedures, contrasted by consistency through time. If modification of diagnostic routines is needed, provision of “scientific facts” and technological aids is insufficient. A prerequisite for changing practice is GPs’ acceptance of accuracy of information and of reliability, applicability, and relevance of technology, for physician and/or patient.

Keywords

Anti-bacterial agents Diagnosis Evidence-based medicine Iceland Infection Physician’s practice patterns 

Notes

Acknowledgments

We thank our informants for the participation and Maxine Ingalls, RN, for proofreading.

Funding

Research is a part of our duties within our ordinary paid jobs. This research was done within that scope.

Conflicts of interest

We have no conflicts of interests to declare.

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Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Ingunn Björnsdóttir
    • 1
    • 2
    Email author
  • Karl G. Kristinsson
    • 2
    • 4
  • Ebba Holme Hansen
    • 1
    • 3
  1. 1.Department of Pharmacology and Pharmacotherapy, Section for Social PharmacyUniversity of CopenhagenCopenhagenDenmark
  2. 2.Research Institute for Pharmaceutical Outcomes and PolicyUniversity of IcelandReykjavíkIceland
  3. 3.FKL—Research Centre for Quality in Medicine UseCopenhagenDenmark
  4. 4.Clinical MicrobiologyLandspitali University HospitalReykjavíkIceland

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