Clinicians’ Views and Experiences of Interventions to Enhance the Quality of Antibiotic Prescribing for Acute Respiratory Tract Infections
- 760 Downloads
Evidence shows a high rate of unnecessary antibiotic prescriptions in primary care in Europe and the United States. Given the costs of widespread use and associated antibiotic resistance, reducing inappropriate use is a public health priority.
We aimed to explore clinicians’ experiences of training in communication skills and use of a patient booklet and/or a C-reactive protein (CRP) point-of-care test to reduce antibiotic prescribing for acute respiratory tract infections (RTIs).
We used a qualitative research approach, interviewing clinicians who participated in a randomised controlled trial (RCT) testing two contrasting interventions.
General practice clinicians in Belgium, England, The Netherlands, Poland, Spain and Wales participated in the study.
Sixty-six semi-structured interviews were transcribed verbatim, translated into English where necessary, and analysed using thematic and framework analysis.
Clinicians from all countries attributed benefits for themselves and their patients to using both interventions. Clinicians reported that the communication skills training and use of the patient booklet gave them greater confidence in addressing patient expectations for an antibiotic by providing answers to common questions and supporting the clinician’s own explanations. Clinicians felt the booklet could be used for a variety of patients and for different types of infections. The CRP test was viewed as a tool to decrease diagnostic uncertainty, to support non-prescription decisions, and to reassure patients, but was only necessary when clinicians were uncertain about the need for antibiotics.
Providing clinicians with training and support tools for use in practice was received positively and was valued by clinicians across countries. Interventions seemed to have influenced behaviour by increasing clinician knowledge about illness severity and prescribing, increasing confidence in making non-prescribing decisions when antibiotics were unnecessary, and enabling clinicians to anticipate positive outcomes when making such decisions. Addressing such determinants of behaviour change enabled interventions to be relevant for clinicians working across different contexts.
KEY WORDSqualitative research decision making antibiotic prescribing communication training point-of-care testing primary care
We thank all participants, clinicians and patients, who took part in the GRACE INTRO trial. We especially thank all the clinicians who consented to be involved in this qualitative study. We also thank all members of the GRACE INTRO consortium whose hard work made the trial and this study possible.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
All authors participated in study concept and design and preparation of the manuscript. SA and STC participated in moderation of interviews, transcript analysis and interpretation, and they take responsibility for the manuscript as a whole. JWC and NAF participated in interpretation of the analysis. PFV, JK, CL, LBH participated in moderation of interviews, checking interpretation and preparation of analysis. All authors read and commented on different versions of the manuscript.
This GRACE/CHAMP study was supported by the European Commission Framework 6 Programme (grant 518226). The work in the UK was also supported by the National Institute for Health Research and the Research Foundation Flanders (grant G.027408N). The work reported on in this publication has been financially supported through the European Science Foundation (ESF), in the framework of the Research Networking Programme TRACE (www.esf.org.trace).
Presented at the General Respiratory Infections Network (GRIN) Annual meeting 2012, Bristol, UK; the South West Society of Academic Primary Care (SW SAPC) conference 2012, Torquay, UK and the 41st Annual Scientific Meeting of the Society of Academic Primary Care (SAPC) 2012, Glasgow, UK. Presentation entitled: “Exploring clinicians’ views across six countries of a near patient test and/or communication skills training as techniques to decrease inappropriate antibiotic prescribing for acute cough”.
- 1.Arnold S, Straus S. Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database Syst Rev. 2005.Google Scholar
- 2.Mc Nulty CAM, Francis NA. Optimizing antibiotic prescribing in primary care settings in the UK: findings of a BSAC multi-disciplinary workshop 2009. JAC. 2010;11:2278–84.Google Scholar
- 4.Baker R, Camosso-Stefinovic J, Gillies C, et al. Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2010.Google Scholar
- 11.Little P, Stuart B, Francis N, et al. The effect of a web-based training in communication skills and an interactive patient booklet and the use of a CRP point of care test in acute respiratory tract infection (RTI): a multi-national cluster randomised factorial controlled trial. Lancet. 2013;382(9899):1175–82.CrossRefPubMedCentralPubMedGoogle Scholar
- 12.Anthierens S, Tonkin-Crine S, Douglas E, et al. General practitioners’ views on the acceptability and applicability of a web-based intervention to reduce antibiotic prescribing for acute cough in multiple European countries: a qualitative study prior to a randomised trial. BMC Fam Pract. 2012;13(1):101.CrossRefPubMedCentralPubMedGoogle Scholar
- 15.Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: Bryman A, Burgess R, eds. Analysing qualitative data. London: Routledge; 1993:173–94.Google Scholar
- 17.Yardley L, Douglas E, Anthierens S, et al. Evaluation of a web-based intervention to reduce antibiotic prescribing for LRTI in six European countries: quantitative process analysis of the GRACE/INTRO randomised controlled trial. Implement Sci. 2013;8:134. doi: 10.1186/1748-5908-8-134.CrossRefPubMedCentralPubMedGoogle Scholar
- 18.Wood F, Brookes-Howell L, Hood K, et al. An ideal test? A multi-country qualitative study of clinicians’ and patients’ views of point of care tests for lower respiratory tract infection in primary care. Fam Pract. 2011;28(6):661–9. doi: 10.1093/fampri/cmr031.
- 29.Brookes-Howell L, Hood K, Cooper L, et al. Understanding variation in primary medical care: a nine-country qualitative study of clinicians’ accounts of the nonclinical factors that shape antibiotic prescribing decisions for lower respiratory tract infections. BMJ Open. 2012;2:e000796. doi: 10.1136/bmjopen-2011-000796.PubMedGoogle Scholar