title: Exploring patients' views of primary care consultations with contrasting interventions for acute cough: a six-country European qualitative study.
abstract: BACKGROUND
  In a pan-European randomised controlled trial (GRACE INTRO) of two interventions, (i) a point-of-care C-reactive protein test and/or (ii) training in communication skills and use of an interactive patient booklet, both interventions resulted in large reductions in antibiotic prescribing for acute cough.
  
  
  OBJECTIVE
  This process evaluation explored patients' views of primary care consultations using the two interventions in six European countries.
  
  
  METHODS
  Sixty-two interviews were conducted with patients who had participated in the GRACE INTRO trial. Interviews were transcribed verbatim and translated into English where necessary. Analysis used techniques from thematic and framework analysis.
  
  
  RESULTS
  Most patients were satisfied with their consultation despite many not receiving an antibiotic. Patients appeared to accept the use of both intervention approaches. A minority, but particularly in the trial arm with both interventions, reported that they would wait longer before consulting for cough in future.
  
  
  CONCLUSIONS
  Patients perceived that both interventions supported the general practitioner's (GP's) prescribing decisions by helping them understand when an antibiotic was, and was not, needed. Patients consulting with acute cough had largely positive views about the GP's enhanced communication skills, which included understanding their concerns, and the use of a near-patient test as an additional investigation.
authors.affiliation: Academic Unit of Primary Care and Population Sciences, University of Southampton, Southampton, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Tonkin-Crine
authors.affiliation: Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.
authors.forename: Sibyl
authors.initials: S
authors.lastname: Anthierens
authors.affiliation: Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK.
authors.forename: Nick A
authors.initials: NA
authors.lastname: Francis
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Curt
authors.initials: C
authors.lastname: Brugman
authors.affiliation: Applied Research in Respiratory Diseases, Hospital Clinic of Barcelona, Barcelona, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Fernandez-Vandellos
authors.affiliation: Department of Family and Community Medicine, Medical University of Lodz, Lodz, Poland.
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Krawczyk
authors.affiliation: Primary Care Centre Jaume I, University Rovira i Virgili, Tarragona, Spain.
authors.forename: Carl
authors.initials: C
authors.lastname: Llor
authors.affiliation: Academic Unit of Psychology, University of Southampton, Southampton, UK.
authors.forename: Lucy
authors.initials: L
authors.lastname: Yardley
authors.affiliation: Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.
authors.forename: Samuel
authors.initials: S
authors.lastname: Coenen
authors.affiliation: Department of Family and Community Medicine, Medical University of Lodz, Lodz, Poland.
authors.forename: Maciek
authors.initials: M
authors.lastname: Godycki-Cwirko
authors.affiliation: Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Butler
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Theo J M
authors.initials: TJ
authors.lastname: Verheij
authors.affiliation: Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.
authors.forename: Herman
authors.initials: H
authors.lastname: Goossens
authors.affiliation: Academic Unit of Primary Care and Population Sciences, University of Southampton, Southampton, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.affiliation: Department of General Practice, Maastricht University, Maastricht, The Netherlands.
authors.forename: Jochen W
authors.initials: JW
authors.lastname: Cals
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001294:Attitude to Health; D003371:Cough / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000379:methods*; D036301:Qualitative Research; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents