Central European Journal of Medicine

, Volume 7, Issue 6, pp 790–799 | Cite as

A study of antibiotic prescribing: the experience of Lithuanian and Russian GPs

  • Lina Jaruseviciene
  • Ruta Radzeviciene-Jurgute
  • Jeffrey V. Lazarus
  • Arnoldas Jurgutis
  • Ingvar Ovhed
  • Eva L. Strandberg
  • Lars Bjerrum
Research Article


Background. Globally, general practitioners (GPs) write more than 90% of all antibiotic prescriptions. This study examines the experiences of Lithuanian and Russian GPs in antibiotic prescription for upper respiratory tract infections, including their perceptions of when it is not indicated clinically or pharmacologically. Methods. 22 Lithuanian and 29 Russian GPs participated in five focus group discussions. Thematic analysis was used to analyse the data. Results. We identified four main thematic categories: patients’ faith in antibiotics as medication for upper respiratory tract infections; patient potential to influence a GP’s decision to prescribe antibiotics for upper respiratory tract infections; impediments perceived by GPs in advocating clinically grounded antibiotic prescribing with their patients, and strategies applied in physician-patient negotiation about antibiotic prescribing for upper respiratory tract infections. Conclusions. Understanding the nature of physician-patient interaction is critical to the effective pursuit of clinically grounded antibiotic use as this study undertaken in Lithuania and the Russian Federation has shown. Both physicians and patients must be targeted to ensure correct antibiotic use. Further, GPs should be supported in enhancing their communication skills about antibiotic use with their patients and encouraged to implement a shared decision-making model in their practices.


Antibiotics Upper respiratory tract infections General practitioners Physician-patient relationships Lithuania Russian Federation 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. [1]
    Grimsmo A, Hagman E, Faiko E, Matthiessen L, Njalsson T. Patients, diagnoses and processes in general practice in the Nordic countries. An attempt to make data from computerised medical records available for comparable statistics. Scand J Prim Health Care 2001, 19:76–82PubMedCrossRefGoogle Scholar
  2. [2]
    André M, Odenholt I, Schwan A, Axelsson I, Eriksson M, Hoffman M, et al. Upper respiratory tract infections in general practice: diagnosis, antibiotic prescribing, duration of symptoms and use of diagnostic tests. Scand J Infect Dis 2002, 34:880–886PubMedCrossRefGoogle Scholar
  3. [3]
    The bacterial challenge: time to react. ECDC/ EMEA joint technical report. European Centre for Disease Prevention and Control, Stockholm, 2009. [, cited 13 July 2010]Google Scholar
  4. [4]
    Welschen I, Kuyvenhoven MM, Hoes AW, Verheij TJ. Effectiveness of a multiple intervention to reduce antibiotic prescribing for respiratory tract symptoms in primary care: randomised controlled trial.BMJ 2004;329:431PubMedCrossRefGoogle Scholar
  5. [5]
    Llor C, Madurell J, Balagué-Corbella M, Gómez M, Cots JM. Impact on antibiotic prescription of rapid antigen detection testing in acute pharyngitis in adults: a randomised clinical trial. Br J Gen Pract 2011; 61:e244–251PubMedCrossRefGoogle Scholar
  6. [6]
    Gould IM, Mackenzie FM, Shepherd L. Use of the bacteriology laboratory to decrease general practitioners’ antibiotic prescribing. Eur J Gen Pract 2007;13:13–15PubMedCrossRefGoogle Scholar
  7. [7]
    van Driel ML, Coenen S, Dirven K, Lobbestael J, Janssens I, Van Royen P, et al. What is the role of quality circles in strategies to optimise antibiotic prescribing? A pragmatic cluster-randomised controlled trial in primary care. Qual Saf Health Care 2007;16:197–202PubMedCrossRefGoogle Scholar
  8. [8]
    Francis NA, Butler CC, Hood K, Simpson S, Wood F, Nuttall J. Effect of using an interactive booklet about childhood respiratory tract infections in primary care consultations on reconsulting and antibiotic prescribing: a cluster randomised controlled trial. BMC Fam Pract 2008; 9:23PubMedCrossRefGoogle Scholar
  9. [9]
    Naughton C, Feely J, Bennett K. A RCT evaluating the effectiveness and cost-effectiveness of academic detailing versus postal prescribing feedback in changing GP antibiotic prescribing. J Eval Clin Pract 2009;15:807–812PubMedCrossRefGoogle Scholar
  10. [10]
    Parish PA: Sociology of prescribing. Br Med Bull 1974, 30:214–217PubMedGoogle Scholar
  11. [11]
    Petursson P: GPs’ reasons for “nonpharmacological” prescribing of antibiotics. A phenomenological study. Scand J Prim Health Care 2005, 23:120–125PubMedCrossRefGoogle Scholar
  12. [12]
    Björnsdóttir I, Hansen EH. Intentions, strategies and uncertainty inherent in antibiotic prescribing. Eur J Gen Pract 2002, 8:18–24CrossRefGoogle Scholar
  13. [13]
    Butler CC, Rollnick S, Pill R, Maggs-Rapport F, Stott N. Understanding the culture of prescribing: qualitative study of general practitioners’ and patients’ perceptions of antibiotics for sore throats. BMJ 1998, 317:637–642PubMedCrossRefGoogle Scholar
  14. [14]
    Altiner A, Knauf A, Moebes J, Sielk M, Wilm S. Acute cough: a qualitative analysis of how GPs manage the consultation when patients explicitly or implicitly expect antibiotic prescriptions. Fam Pract 2004, 21:500–506PubMedCrossRefGoogle Scholar
  15. [15]
    Altiner A, Brockmann S, Sielk M, Wilm S, Wegscheider K, Abholz HH. Reducing antibiotic prescriptions for acute cough by motivating GPs to change their attitudes to communication and empowering patients: a cluster-randomized intervention study. J Antimicrob Chemother 2007, 60:638–644PubMedCrossRefGoogle Scholar
  16. [16]
    Wilson AA, Crane LA, Barrett PH, Gonzales R. Public beliefs and use of antibiotics for acute respiratory illness. J Gen Intern Med 1999, 14:658–662PubMedCrossRefGoogle Scholar
  17. [17]
    Bagshaw SM, Kellner JD. Beliefs and behaviours of parents regarding antibiotic use by children. Can J Infect Dis 2001, 12:93–97PubMedGoogle Scholar
  18. [18]
    Macfarlane J, Holmes W, Macfarlane R, Britten N. Influence of patients’ expectations on antibiotic management of acute lower respiratory tract illness in general practice: questionnaire study. BMJ 1997, 315:1211–1214PubMedCrossRefGoogle Scholar
  19. [19]
    Welschen I, Kuyvenhoven M, Hoes A, Verheij T. Antibiotics for acute respiratory tract symptoms: patients’ expectations, GPs’ management and patient satisfaction. Fam Pract 2004, 21:234–237PubMedCrossRefGoogle Scholar
  20. [20]
    Tuckett D, Boulton M, Olson C, Williams A. Meetings Between Experts. London and New York: Tavistok Publications; 1985Google Scholar
  21. [21]
    Netleton S. The Sociology of Health and Illness. 2nd edition. Cambridge: Polity Press; 2006Google Scholar
  22. [22]
    Vanden Eng J, Marcus R, Hadler JL, Imhoff B, Vugia DJ, Cieslak PR, et al. Consumer attitudes and use of antibiotics. Emerg Infect Dis 2003, 9:1128–1135PubMedCrossRefGoogle Scholar
  23. [23]
    McNulty CA, Boyle P, Nichols T, Clappison P, Davey P. Don’t wear me out: the public’s knowledge of and attitudes to antibiotic use. J Antimicrob Chemother 2007, 59:727–738PubMedCrossRefGoogle Scholar
  24. [24]
    Butler CC, Kinnersley P, Prout H, Rollnick S, Edwards A, Elwyn G. Antibiotics and shared decision-making in primary care. J Antimicrob Chemother 2001, 48:435–440PubMedCrossRefGoogle Scholar
  25. [25]
    Goossens H, Ferech M, Vander Stichele R, Elseviers M. ESAC Project Group. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 2005;365:579–587PubMedGoogle Scholar
  26. [26]
    Butler CC, Hood K, Verheij T, Little P, Melbye H, Nuttall J, et al. Variation in antibiotic prescribing and its impact on recovery in patients with acute cough in primary care: prospective study in 13 countries. BMJ 2009;338:b2242PubMedCrossRefGoogle Scholar
  27. [27]
    Vlahovic-Palcevski V, Dumpis U, Mitt P, Gulbinovic J, Struwe J, Palcevski G, et al. Benchmarking antimicrobial drug use at university hospitals in five European countries. Clin Microbiol Infect 2007, 13:277–283PubMedCrossRefGoogle Scholar
  28. [28]
    Dumpis U, Gulbinovic J, Struwe J, Lagergren A, Griskevicius L, Bergman U. Differences in antibiotic prescribing in three university hospitals in the Baltic region revealed by a simple protocol for quality assessment of therapeutic indications. Int J Clin Pharmacol Ther 2007, 45:568–576PubMedGoogle Scholar
  29. [29]
    Palcevski G, Ahel V, Vlahovic-Palcevski V, Ratchina S, Rosovic-Bazijanac V, Averchenkova L. Antibiotic use profile at paediatric clinics in two transitional countries. Pharmacoepidemiol Drug Saf 2004, 13:181–185PubMedCrossRefGoogle Scholar
  30. [30]
    Sanz E, Hernandez MA, Ratchina S, Stratchounsky L, Peire MA, Lapeyre-Mestre M, et al. Drug utilisation in outpatient children. A comparison among Tenerife, Valencia, and Barcelona (Spain), Toulouse (France), Sofia (Bulgaria), Bratislava (Slovakia) and Smolensk (Russia). Eur J Clin Pharmacol 2004, 60:127–134PubMedCrossRefGoogle Scholar
  31. [31]
    Balabanova Y, Fedorin I, Kuznetsov S, Graham C, Ruddy M, Atun R, et al. Antimicrobial prescribing patterns for respiratory diseases including tuberculosis in Russia: a possible role in drug resistance? J Antimicrob Chemother 2004, 54:673–679PubMedCrossRefGoogle Scholar
  32. [32]
    Galinyte D, Maciulaitis R, Budnikas V, Kubilius D, Varanaviciene B, Vitkauskiene A, et al. Analysis of antibiotic consumption and microorganism resistance changes (Antibiotiku vartojimo ir kai kuriu mikroorganizamu atsparumo pokyciu analize). Medicina (Kaunas) 2008, 44:751–767 (in Lithuanian)Google Scholar
  33. [33]
    Grigoryan L, Burgerhof JG, Degener JE, Deschepper R, Lundborg CS, Monnet DL, et al. Attitudes, beliefs and knowledge concerning antibiotic use and self-medication: a comparative European study. Pharmacoepidemiol Drug Saf 2007, 16:1234–1243PubMedCrossRefGoogle Scholar
  34. [34]
    Stratchounski LS, Andreeva IV, Ratchina SA, Galkin DV, Petrotchenkova NA, Demin AA, et al. The inventory of antibiotics in Russian home medicine cabinets. Clin Infect Dis 2003, 37:498–505PubMedCrossRefGoogle Scholar
  35. [35]
    Leonavicius V, Baltrusaityte G, Naujokaite I. Sociology and the user of the health services. The University of Vytautas Magnus, Kaunas, 2007 [in Lithuanian]Google Scholar
  36. [36]
    Bjerrum L, Munck A, Gahrn-Hansen B. Hansen MP, Jarboel D, Llor C et al.: Health Alliance for Prudent Prescribing, Yield and Use of Antimicrobial Drugs in the Treatment of Respiratory Tract Infections (HAPPY AUDIT). BMC Fam Pract 2010, 11:29PubMedCrossRefGoogle Scholar
  37. [37]
    Rabiee F. Focus-group interview and data analysis. Proceedings of the Nutrition Society 2004, 63:655–660PubMedCrossRefGoogle Scholar
  38. [38]
    Thomas L, Mac Millan J, McColl E, Hale c, Bond S. Comparison of focus group and individual interview methodology in examining patient satisfaction with nursing care. Social Sciences in Health 1995, 1:206–219Google Scholar
  39. [39]
    Morgan DL. The Focus Group Guidebook. California: Sage Publications; 1998Google Scholar
  40. [40]
    Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology 2006, 3:77–101CrossRefGoogle Scholar
  41. [41]
    Hawkings NJ, Butler CC, Wood F. Antibiotics in the community: a typology of user behaviours. Patient Educ Couns 2008, 73: 146–152PubMedCrossRefGoogle Scholar
  42. [42]
    Kavanagh KE, O’shea E, Halloran R, Cantillon P, Murphy AW. A pilot study of the use of near-patient C-Reactive Protein testing in the treatment of adult respiratory tract infections in one Irish general practice. BMC Fam Pract. 2011;12:93PubMedCrossRefGoogle Scholar
  43. [43]
    Butler CC, Simpson S, Wood F. General practitioners’ perceptions of introducing nearpatient testing for common infections into routine primary care: a qualitative study. Scand J Prim Health Care 2008;26:17–21PubMedCrossRefGoogle Scholar
  44. [44]
    Horton R. Second Opinion: Doctors, Diseases and Decisions in Modern Medicine. London: Granta Books; 2003Google Scholar
  45. [45]
    Stearns CR, Gonzales R, Camargo CA Jr, Maselli J, Metlay JP. Antibiotic prescriptions are associated with increased patient satisfaction with emergency department visits for acute respiratory tract infections. Acad Emerg Med. 2009;16:934–941PubMedCrossRefGoogle Scholar
  46. [46]
    Coulter A, Elwyn G. What do patients want from high-quality general practice and how do we involve them in improvement. Br J Gen Pract 2002, 52Suppl: S22–S26PubMedGoogle Scholar
  47. [47]
    Avorn J, Solomon DH. Cultural and economic factors that (mis)shape antibiotic use: the nonpharmacologic basis of therapeutics. Ann Intern Med 2000, 133:128–135PubMedGoogle Scholar
  48. [48]
    European Antibiotic Awareness Day 2010 [, cited 7 June 2010]
  49. [49]
    Cals JW, Butler CC, Hopstaken RM, Hood K, Dinant GJ. Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial. BMJ 2009; 338:b1374PubMedCrossRefGoogle Scholar
  50. [50]
    Tonkin-Crine S, Yardley L, Little P. Antibiotic prescribing for acute respiratory tract infections in primary care: a systematic review and metaethnography. J Antimicrob Chemother 2011; 66:2215–2223PubMedCrossRefGoogle Scholar
  51. [51]
    Francis NA, Butler CC, Hood K, Simpson S, Wood F, Nuttall J. Effect of using an interactive booklet about childhood respiratory tract infections in primary care consultations on reconsulting and antibiotic prescribing: a cluster randomised controlled trial. BMJ 2009;339:b2885PubMedCrossRefGoogle Scholar
  52. [52]
    Spurling GK, Del Mar CB, Dooley L, Foxlee R. Delayed antibiotics for respiratory infections. Cochrane Database Syst Rev 2007, (3):CD004417Google Scholar
  53. [53]
    Hoye S, Frich JC, Lidbaek. Delayed prescribing for upper respiratory tract infections: a qualitative study of GP’s experiences. Brit J Gen Pract 2010, 60:907–912CrossRefGoogle Scholar
  54. [54]
    Moore M, Little P, Rumsby K, Kelly J, Watson L, Warner G, et al. Effect of antibiotic prescribing strategies and an information leaflet on longerterm reconsultation for acute lower respiratory tract infection. Br J Gen Pract. 2009, 59:728–734PubMedCrossRefGoogle Scholar
  55. [55]
    Jurgutis A, Martinkenas A, Radzeviciene R, Bumblys A, Jaruseviciene L, Bjerrum L. Patterns of prescription of antibiotics for children respiratory infections among primary health care physicians of Klaipeda region. 17th Nordic Congress of General Practice. Tromso, Norway, 14–17June, 2011Google Scholar

Copyright information

© Versita Warsaw and Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Lina Jaruseviciene
    • 1
  • Ruta Radzeviciene-Jurgute
    • 2
  • Jeffrey V. Lazarus
    • 3
  • Arnoldas Jurgutis
    • 2
  • Ingvar Ovhed
    • 4
  • Eva L. Strandberg
    • 4
    • 5
  • Lars Bjerrum
    • 6
    • 7
  1. 1.Department of Family MedicineLithuanian University of Health SciencesKaunasLithuania
  2. 2.Department of Public HealthKlaipeda UniversityKlaipedaLithuania
  3. 3.Copenhagen HIV Programme, ISIMUniversity of CopenhagenCopenhagenDenmark
  4. 4.Blekinge Competence CentreBlekinge County CouncilKarlskronaSweden
  5. 5.Department of Clinical Sciences, Malmö, General Practice/Family Medicine, Malmö University HospitalLund UniversityLundSweden
  6. 6.Research Unit of General PracticeUniversity of Southern DenmarkOdenseDenmark
  7. 7.Research Unit for General Practice and Section of General Practice, Department of Public HealthUniversity of CopenhagenCopenhagenDenmark

Personalised recommendations