Clinicians' views and experiences of interventions to enhance the quality of antibiotic prescribing for acute respiratory tract infections.
BACKGROUND
Evidence shows a high rate of unnecessary antibiotic prescriptions in primary care in Europe and the United States. Given the costs of widespread use and associated antibiotic resistance, reducing inappropriate use is a public health priority.


OBJECTIVE
We aimed to explore clinicians' experiences of training in communication skills and use of a patient booklet and/or a C-reactive protein (CRP) point-of-care test to reduce antibiotic prescribing for acute respiratory tract infections (RTIs).


METHODS
We used a qualitative research approach, interviewing clinicians who participated in a randomised controlled trial (RCT) testing two contrasting interventions.


METHODS
General practice clinicians in Belgium, England, The Netherlands, Poland, Spain and Wales participated in the study.


METHODS
Sixty-six semi-structured interviews were transcribed verbatim, translated into English where necessary, and analysed using thematic and framework analysis.


RESULTS
Clinicians from all countries attributed benefits for themselves and their patients to using both interventions. Clinicians reported that the communication skills training and use of the patient booklet gave them greater confidence in addressing patient expectations for an antibiotic by providing answers to common questions and supporting the clinician's own explanations. Clinicians felt the booklet could be used for a variety of patients and for different types of infections. The CRP test was viewed as a tool to decrease diagnostic uncertainty, to support non-prescription decisions, and to reassure patients, but was only necessary when clinicians were uncertain about the need for antibiotics.


CONCLUSIONS
Providing clinicians with training and support tools for use in practice was received positively and was valued by clinicians across countries. Interventions seemed to have influenced behaviour by increasing clinician knowledge about illness severity and prescribing, increasing confidence in making non-prescribing decisions when antibiotics were unnecessary, and enabling clinicians to anticipate positive outcomes when making such decisions. Addressing such determinants of behaviour change enabled interventions to be relevant for clinicians working across different contexts.
Department of Primary Care and Interdisciplinary Care, University of Antwerp, Universiteitsplein 1, 2016, Wilrijk, Belgium, sibyl.anthierens@uantwerpen.be.
Sibyl
S
Anthierens
Sarah
S
Tonkin-Crine
Jochen W
JW
Cals
Samuel
S
Coenen
Lucy
L
Yardley
Lucy
L
Brookes-Howell
Patricia
P
Fernandez-Vandellos
Jaroslaw
J
Krawczyk
Maciek
M
Godycki-Cwirko
Carl
C
Llor
Christopher C
CC
Butler
Theo
T
Verheij
Herman
H
Goossens
Paul
P
Little
Nick A
NA
Francis
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D011307:Drug Prescriptions / Q000592:standards*; D004352:Drug Resistance, Microbial; D005260:Female; D058005:General Practitioners / Q000193:education / Q000592:standards*; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods; D011787:Quality of Health Care / Q000592:standards*; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000453:epidemiology
D000900:Anti-Bacterial Agents