"I'm Dr Jekyll and Mr Hyde": are GPs' antibiotic prescribing patterns contextually dependent? A qualitative focus group study.
OBJECTIVE
To explore factors and circumstances contributing to prudent antibiotic prescribing for respiratory tract infections in primary care.


METHODS
Two focus groups representing rural and urban areas. A semi-structured interview guide with open-ended questions and an editing analysis style was used. They were examined to identify meaning units that were sorted into categories in an iterative process throughout the analysis.


METHODS
Primary health care in two counties in southern Sweden.


METHODS
Two groups including seven and six general practitioners (GPs) respectively, men and women of different ages with different professional experiences.


METHODS
Exploration of categories, determination of themes, construction of models.


RESULTS
The decision to prescribe antibiotics takes place in the encounter between GP and patient, initially characterized by harmony or fight and the subsequent process by collaboration or negotiation, resulting in agreement, compromise, or disagreement. Several factors influence the meeting and contribute to enhancing the conditions for rational prescribing. These conditions are connected to the GP, the relationship, and the setting; organization as well as professional culture. The findings indicate synergies between the factors, and that one factor can sometimes compensate for lack of another. Continuity and mutual trust can make a brief consultation successful, but lack of continuity can eliminate the effects of knowledge and professional skills.


CONCLUSIONS
The findings emphasize the importance of the encounter between the GP and the patient for prudent antibiotic prescribing. Furthermore, the importance of an appropriate organization of primary care, which promotes continuity and encourages professional autonomy, is demonstrated.
Department of Clinical Sciences, Lund University, Malmö, Sweden. eva-lena.strandberg@med.lu.se
Eva Lena
EL
Strandberg
Annika
A
Brorsson
Charlotta
C
Hagstam
Margareta
M
Troein
Katarina
K
Hedin
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D017144:Focus Groups; D058005:General Practitioners / Q000592:standards; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D017009:Professional Autonomy; D036301:Qualitative Research; D012017:Referral and Consultation; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D013548:Sweden; D055815:Young Adult
D000900:Anti-Bacterial Agents