title: Managing self-limiting respiratory tract infections: a qualitative study of the usefulness of the delayed prescribing strategy.
abstract: Despite respiratory tract infections usually being viral and self-limiting, most primary care consultations still result in an antibiotic prescription. The National Institute for Health and Clinical Excellence (NICE) introduced the 'delayed prescribing' (DP) strategy. It remains unknown how useful UK clinicians find this approach.
  
  
  
  To investigate how DP is used within UK primary care, and the benefits and challenges associated with this strategy.
  
  
  
  Qualitative interview and focus group study in UK scheduled and unscheduled care primary care settings.
  
  
  
  Data were gathered through semi-structured interviews (n = 49) and six focus groups with GPs, trainee GPs, and nurse prescribers (NPs). An iterative analysis approach, using grounded theory principles, was used to generate themes from the dataset.
  
  
  
  Prescribers were familiar with DP but used it infrequently. DP was often used to manage diagnostic uncertainty, although NPs, trainee GPs, and GPs working in unscheduled care services preferred patients to reconsult under these circumstances. Prescribers used DP to avoid conflict, although some had found more effective strategies to achieve this. Prescribers were generally uncomfortable giving clinical responsibility to patients, and DP was perceived to communicate a conflicting message to patients about antibiotic efficacy.
  
  
  
  DP was not considered to be a helpful strategy for managing patients with self-limiting respiratory tract infections within primary care and the findings do not support the centrality of DP in NICE guidelines as a primary means of reducing antibiotic prescribing. Future training and guidelines should encourage alternative ways of communicating empathy, addressing patient beliefs, and encouraging self-management.
authors.affiliation: School of Psychological Sciences, University of Manchester, Manchester, UK. sarah.peters@manchester.ac.uk
authors.forename: Sarah
authors.initials: S
authors.lastname: Peters
authors.forename: Samantha
authors.initials: S
authors.lastname: Rowbotham
authors.forename: Anna
authors.initials: A
authors.lastname: Chisholm
authors.forename: Alison
authors.initials: A
authors.lastname: Wearden
authors.forename: Susie
authors.initials: S
authors.lastname: Moschogianis
authors.forename: Lis
authors.initials: L
authors.lastname: Cordingley
authors.forename: David
authors.initials: D
authors.lastname: Baker
authors.forename: Catherine
authors.initials: C
authors.lastname: Hyde
authors.forename: Carolyn
authors.initials: C
authors.lastname: Chew-Graham
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D055553:Prescription Drugs / Q000627:therapeutic use*; D036301:Qualitative Research; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D013997:Time Factors; D006113:United Kingdom; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D055553:Prescription Drugs