Delayed antibiotic prescriptions: what are the experiences and attitudes of physicians and patients?
OBJECTIVE
To explore the experiences and opinions of family physicians and patients regarding the delay of antibiotic prescriptions, to be dispensed if symptoms persist or worsen over time, in treating upper respiratory tract infections.


METHODS
Qualitative study using semistructured interviews conducted in family practice in Auckland, New Zealand.


METHODS
Thirteen physicians recruited from a study of family physicians' reported antibiotic prescribing and 13 patients recruited from the intervention arm of a randomized controlled trial on delayed antibiotic prescribing.


METHODS
Patients' and physicians' experiences of delayed antibiotic prescriptions for upper respiratory tract infections.


RESULTS
The primary themes identified were value judgments of antibiotics, decreased antibiotic use, patient-centered factors, effects on the physician-patient relationship, patient convenience, adverse effects of delaying prescription, and selectivity for use of antibiotics. Many themes were common to both patients and physicians. Physicians valued empowering patients' decision making about their health care management more highly than did patients. Decreasing antibiotic use was not a key factor for most patients. Both groups acknowledged the value in saving patients time and money. Physicians viewed the strategy as giving patients reassurance and meeting their expectations for antibiotics. Negative implications included perception of physician incompetence and physician loss of management control. Opinions were mixed regarding which patients, under which conditions, were suitable for delayed antibiotic prescriptions.


CONCLUSIONS
Although delayed antibiotic prescriptions are effective in decreasing antibiotic use for conditions not clinically warranting antibiotics, neither patients nor physicians universally endorsed this strategy. Research to establish formalized recommendations for patient suitability and instructions for use would be of value.
Arroll
Bruce
B
Division of General Practice Primary Health Care, Faculty of Medical Health Sciences, University of Auckland Private Bag 92019, Auckland, New Zealand. b.arroll@auckland.ac.nz
Goodyear-Smith
Felicity
F
Thomas
David R
DR
Kerse
Ngaire
N
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001291:Attitude of Health Personnel; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004352:Drug Resistance, Microbial; D004363:Drug Utilization; D005194:Family Practice / Q000592:standards* / Q000639:trends; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010818:Practice Patterns, Physicians'; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy*; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D013997:Time Factors
D000900:Anti-Bacterial Agents