Antibiotic prescribing for acute respiratory tract infections in primary care: a systematic review and meta-ethnography
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TLDR
Interventions should allow GPs to reflect on their own prescribing; help decrease uncertainty about appropriate ARTI management; educate GPs about appropriate prescribing; facilitate more patient-centred care; and be beneficial to implement in practice.Abstract:
Objectives: Numerous interventions have been developed to promote prudent antibiotic use for acute respiratory tract infections (ARTIs). While reviews have assessed which interventions may be most effective, none has examined why some interventions may be more effective than others. Knowing what general practitioners (GPs) feel is acceptable and feasible to implement may help to answer this question. Methods: A systematic review was undertaken of 12 studies of GPs' views and experiences of antibiotic prescribing and/or interventions promoting the prudent use of antibiotics. A meta-ethnographic approach was followed to synthesize the findings. Results: Thirteen themes were identified from the synthesis. The first discussed GPs' satisfaction with their prescribing decisions. Seven themes highlighted factors that influence GPs' prescribing decisions; these included perceptions of external pressure to reduce prescribing, uncertainty about ARTI management and previous experience of ARTI management. Five themes highlighted the benefits of interventions that had helped GPs to prescribe more prudently in practice. The last two sets of themes were linked to indicate that interventions may only be beneficial for GPs when they address one or more of the factors that influence their prescribing decisions. Conclusions: The findings suggest that interventions should incorporate five aspects to promote prudent use whilst remaining attractive to GPs and feasible in practice. In order to maximize acceptability, interventions should: allow GPs to reflect on their own prescribing; help decrease uncertainty about appropriate ARTI management; educate GPs about appropriate prescribing; facilitate more patient-centred care; and be beneficial to implement in practice. © The Author 2011. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.read more
Citations
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Understanding physician antibiotic prescribing behaviour: a systematic review of qualitative studies.
António Teixeira Rodrigues,António Teixeira Rodrigues,Fátima Roque,Fátima Roque,Amílcar Falcão,Adolfo Figueiras,Maria Teresa Herdeiro +6 more
TL;DR: It is revealed that: (i) antibiotic prescribing is a complex process influenced by factors affecting all the actors involved, including physicians, other healthcare providers, healthcare system, patients and the general public; and (ii) such factors are mutually dependent.
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Time of Day and the Decision to Prescribe Antibiotics
Jeffrey A. Linder,Jeffrey A. Linder,Jason N. Doctor,Mark W. Friedberg,Mark W. Friedberg,Mark W. Friedberg,Harry Reyes Nieva,Harry Reyes Nieva,Caroline Birks,Daniella Meeker,Craig R. Fox +10 more
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Clinician‐targeted interventions to influence antibiotic prescribing behaviour for acute respiratory infections in primary care: an overview of systematic reviews
Sarah Tonkin-Crine,Pui San Tan,Oliver van Hecke,Kay Wang,Nia Roberts,Amanda McCullough,Malene Plejdrup Hansen,Christopher C Butler,Chris Del Mar +8 more
TL;DR: Moderate-quality evidence was found that procalcitonin-guided management probably reduces antibiotic prescribing in emergency departments and the overall effect of these interventions was small, but likely to be clinically important.
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“It's safer to …” parent consulting and clinician antibiotic prescribing decisions for children with respiratory tract infections: An analysis across four qualitative studies
TL;DR: A cross-study analysis of four studies aimed to understand the drivers of parental consulting and clinician prescribing behaviour when children under 12 years consult primary care with acute respiratory tract infections found the social construction of children as vulnerable and normative beliefs about the roles of parents and clinicians were reflected in parents' and clinicians' beliefs and decision making.
References
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Journal ArticleDOI
Outpatient antibiotic use in Europe and association with resistance: a cross-national database study
TL;DR: Outpatient antibiotic use in 26 countries in Europe between Jan 1, 1997, and Dec 31, 2002 was investigated by calculating the number of defined daily doses (DDD) per 1000 inhabitants per day according to WHO anatomic therapeutic chemical classification and DDD measurement methodology, and the ecological association between antibiotic use and antibiotic resistance rates was assessed using Spearman's correlation coefficients.
Book
Meta-Ethnography: Synthesizing Qualitative Studies
George W. Noblit,R. Dwight Hare +1 more
TL;DR: In this paper, the idea of a meta-ethnography was introduced and a Meta-Ethnographic Approach was proposed to construct META-ETHNOGRAPHIES Reciprocal Translations as Synthesis this paper.
Journal ArticleDOI
Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis
TL;DR: Individuals prescribed an antibiotic in primary care for a respiratory or urinary infection develop bacterial resistance to that antibiotic, which not only increases the population carriage of organisms resistant to first line antibiotics, but also creates the conditions for increased use of second line antibiotics in the community.
Journal ArticleDOI
Resisting medicines: a synthesis of qualitative studies of medicine taking
Pandora Pound,Nicky Britten,Myfanwy Morgan,Lucy Yardley,Catherine Pope,Gavin Daker-White,Rona Campbell +6 more
TL;DR: It is argued that peoples' resistance to medicine taking needs to be recognised and that the focus should be on developing ways of making medicines safe, as well as identifying and evaluating the treatments that people often choose in preference to medicines.
Journal ArticleDOI
Interventions to improve antibiotic prescribing practices in ambulatory care
TL;DR: Multi-faceted interventions combining physician, patient and public education in a variety of venues and formats were the most successful in reducing antibiotic prescribing for inappropriate indications.
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