title: Primary care clinicians' perceptions about antibiotic prescribing for acute bronchitis: a qualitative study.
abstract: BACKGROUND
  Clinicians prescribe antibiotics to over 65% of adults with acute bronchitis despite guidelines stating that antibiotics are not indicated.
  
  
  METHODS
  To identify and understand primary care clinician perceptions about antibiotic prescribing for acute bronchitis, we conducted semi-structured interviews with 13 primary care clinicians in Boston, Massachusetts and used thematic content analysis.
  
  
  RESULTS
  All the participants agreed with guidelines that antibiotics are not indicated for acute bronchitis and felt that clinicians other than themselves were responsible for overprescribing. Barriers to guideline adherence included 6 themes: (1) perceived patient demand, which was the main barrier, although some clinicians perceived a recent decrease; (2) lack of accountability for antibiotic prescribing; (3) saving time and money; (4) other clinicians' misconceptions about acute bronchitis; (5) diagnostic uncertainty; and (6) clinician dissatisfaction in failing to meet patient expectations. Strategies to decrease inappropriate antibiotic prescribing included 5 themes: (1) patient educational materials; (2) quality reporting; (3) clinical decision support; (4) use of an over-the-counter prescription pad; and (5) pre-visit triage and education by nurses to prevent visits.
  
  
  CONCLUSIONS
  Clinicians continued to cite patient demand as the main reason for antibiotic prescribing for acute bronchitis, though some clinicians perceived a recent decrease. Clinicians felt that other clinicians were responsible for inappropriate antibiotic prescribing and that better pre-visit triage by nurses could prevent visits and change patients' expectations.
authors.affiliation: Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA. pdempsey1@partners.org.
authors.forename: Patrick P
authors.initials: PP
authors.lastname: Dempsey
authors.affiliation: Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA. abusinger@partners.org.
authors.forename: Alexandra C
authors.initials: AC
authors.lastname: Businger
authors.affiliation: Bureau of Infectious Diseases, Massachusetts Department of Public Health, Boston, MA, USA. lewhaley@gmail.com.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Whaley
authors.affiliation: Survey and Data Management Core, Dana Farber Cancer Institute, Boston, MA, USA. jjgagne@partners.org.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Gagne
authors.affiliation: Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA. jlinder@partners.org.|Harvard Medical School, Boston, MA, USA. jlinder@partners.org.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Linder
mesh_terms: D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D001991:Bronchitis / Q000188:drug therapy*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D058007:Physicians, Primary Care; D017410:Practice Guidelines as Topic; D036301:Qualitative Research
chemical_list: D000900:Anti-Bacterial Agents