title: Using qualitative insights to change practice: exploring the culture of antibiotic prescribing and consumption for urinary tract infections.
abstract: OBJECTIVE
  The aim of this paper is to explore the culture of antibiotic prescribing and consumption in the community for urinary tract infections (UTI) from the perspective of the general practitioners (GPs) and community member.
  
  
  METHODS
  Indepth interviews were conducted with GPs, and focus groups were held with community members.
  
  
  METHODS
  General practice and community setting.
  
  
  METHODS
  15 GPs practising in rural and urban locations in Ireland participated in the indepth interviews. 6 focus groups (n=42) with participants who had direct or indirect experiences with UTI were also undertaken.
  
  
  RESULTS
  The decision to prescribe or consume an antibiotic for a UTI is a set of complex processes including need recognition, information search and evaluation processes governed by the relationship and interactions between the GP and the patient. Different GP and patient decision-making profiles emerged emphasising the diversity and variety of general practice in real-life settings. The GP findings showed a requirement for more microbiological information on antibiotic resistance patterns to inform prescribing decisions. Focus group participants wanted a conversation with the GP about their illness and the treatment options available.
  
  
  CONCLUSIONS
  Collectively, this research identified the consultation as a priority intervention environment for stimulating change in relation to antibiotics. This paper demonstrates how qualitative research can identify the interacting processes which are instrumental to the decision to prescribe or consume an antibiotic for a suspected UTI. Qualitative research empowers researchers to investigate the what, how and why of interventions in real-life setting. Qualitative research can play a critical and instrumental role in designing behavioural change strategies with high impact on practice. The results of this research were used to design a complex intervention informed by social marketing.
  
  
  BACKGROUND
  NCT01913860; Pre-results.
authors.affiliation: Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland.
authors.forename: Sinead
authors.initials: S
authors.lastname: Duane
authors.affiliation: Discipline of Marketing, J.E. Cairnes School of Business and Economics, National University of Ireland Galway, Galway, Ireland.
authors.forename: Christine
authors.initials: C
authors.lastname: Domegan
authors.affiliation: Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland Discipline of Economics, J.E. Cairnes School of Business and Economics, National University of Ireland Galway, Galway, Ireland.
authors.forename: Aoife
authors.initials: A
authors.lastname: Callan
authors.affiliation: Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland.
authors.forename: Sandra
authors.initials: S
authors.lastname: Galvin
authors.affiliation: Discipline of Bacteriology, School of Medicine, National University of Ireland Galway, Galway, Ireland Department of Medical Microbiology, University Hospital Galway, Galway, Ireland.
authors.forename: Martin
authors.initials: M
authors.lastname: Cormican
authors.affiliation: Department of Pharmacology & Therapeutics, Trinity College Dublin, Ireland.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Bennett
authors.affiliation: Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Murphy
authors.affiliation: Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland Discipline of Bacteriology, School of Medicine, National University of Ireland Galway, Galway, Ireland.
authors.forename: Akke
authors.identifier: http://orcid.org/0000-0002-6583-4300
authors.initials: A
authors.lastname: Vellinga
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D005260:Female; D017144:Focus Groups; D058006:General Practice / Q000706:statistics & numerical data; D058005:General Practitioners / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D007494:Ireland; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D036301:Qualitative Research; D014552:Urinary Tract Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents
keywords: PRIMARY CARE; QUALITATIVE RESEARCH