title: Why do general practitioners prescribe antibiotics for upper respiratory tract infections to meet patient expectations: a mixed methods study.
abstract: To describe the role patient expectations play in general practitioners (GPs) antibiotic prescribing for upper respiratory tract infections (URTI).
  
  
  
  Concurrent explanatory mixed methods approach using a cross-sectional survey and semistructured interviews.
  
  
  
  Primary care GPs in Australia.
  
  
  
  584 GPs (response rate of 23.6%) completed the cross-sectional survey. 32 GPs were interviewed individually.
  
  
  
  Prescribing of antibiotics for URTI.
  
  
  
  More than half the GP respondents to the survey in Australia self-reported that they would prescribe antibiotics for an URTI to meet patient expectations. Our qualitative findings suggest that 'patient expectations' may be the main reason given for inappropriate prescribing, but it is an all-encompassing phrase that includes other reasons. These include limited time, poor doctor-patient communication and diagnostic uncertainty. We have identified three role archetypes to explain the behaviour of GPs in reference to antibiotic prescribing for URTIs. The main themes emerging from the qualitative component was that many GPs did not think that antibiotic prescribing in primary care was responsible for the development of antibiotic resistance nor that their individual prescribing would make any difference in light of other bigger issues like hospital prescribing or veterinary use. For them, there were negligible negative consequences from their inappropriate prescribing.
  
  
  
  There is a need to increase awareness of the scope and magnitude of antibiotic resistance and the role primary care prescribing plays, and of the contribution of individual prescribing decisions to the problem of antibiotic resistance.
authors: Population Health, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.
authors: Stephanie
authors: S
authors: Fletcher-Lartey
authors: Evaluation, NPS MedicineWise, Sydney, New South Wales, Australia.
authors: Melissa
authors: M
authors: Yee
authors: Oslo kommune Helseetaten, Oslo, Norway.
authors: Christina
authors: C
authors: Gaarslev
authors: Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia.
authors: Rabia
authors: R
authors: Khan
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D001315:Australia; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004352:Drug Resistance, Microbial; D005194:Family Practice; D005260:Female; D058005:General Practitioners; D006801:Humans; D057970:Inappropriate Prescribing; D008297:Male; D008875:Middle Aged; D009042:Motivation; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D055656:Prescriptions; D011320:Primary Health Care; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D057566:Self Report
chemical_list: D000900:Anti-Bacterial Agents
keywords: PRIMARY CARE; antibiotics; inappropriate prescribing; upper respiratory tract infection