title: Antibiotics for acute respiratory tract infections: a mixed-methods study of patient experiences of non-medical prescriber management.
abstract: To (1) explore patients' expectations and experiences of nurse and pharmacist non-medical prescriber-led management of respiratory tract infections (RTIs), (2) examine whether patient expectations for antibiotics affect the likelihood of receiving them and (3) understand factors influencing patient satisfaction with RTI consultations.
  
  
  
  Mixed methods.
  
  
  
  Primary care.
  
  
  
  Questionnaires from 120 patients and follow-up interviews with 22 patients and 16 nurse and pharmacist non-medical prescribers (NMPs).
  
  
  
  Patients had multiple expectations of their consultation with 43% expecting to be prescribed an antibiotic. There was alignment between self-reported patient expectations and those perceived by NMPs. Patient expectations for non-antibiotic strategies, such as education to promote self-management, were associated with receipt of those strategies, whereas patient expectations for an antibiotic were not associated with receipt of these medications. 'Patient-centred' management strategies (including reassurance and providing information) were received by 86.7% of patients. Regardless of patients' expectations or the management strategy employed, high levels of satisfaction were reported for all aspects of the consultation. Taking concerns seriously, conducting a physical examination, communicating the treatment plan, explaining treatment decisions and lack of time restrictions were each reported to contribute to patient satisfaction.
  
  
  
  NMPs demonstrate an understanding of patient expectations of RTI consultations and use a range of non-antibiotic management strategies, particularly those resembling a patient-centred approach. Overall, patients' expectations were met and prescribers were not unduly influenced by patient expectations for an antibiotic. Patients were satisfied with the consultation, indicating that strategies used by NMPs were acceptable. However, the lower levels of satisfaction among patients who expected but did not receive an antibiotic indicates that although NMPs appear to have strategies for managing RTI consultations, there is still scope for improvement and these prescribers are therefore an important group to involve in antimicrobial stewardship.
authors.affiliation: School of Healthcare Sciences, Cardiff University, Cardiff, UK.
authors.forename: Molly
authors.initials: M
authors.lastname: Courtenay
authors.affiliation: Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia.|The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales, Australia.
authors.forename: Samantha
authors.initials: S
authors.lastname: Rowbotham
authors.affiliation: Reading School of Pharmacy, Reading, UK.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Lim
authors.affiliation: Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK.
authors.forename: Rhian
authors.initials: R
authors.lastname: Deslandes
authors.affiliation: Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Hodson
authors.affiliation: School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK.
authors.forename: Katie
authors.initials: K
authors.lastname: MacLure
authors.affiliation: Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Peters
authors.affiliation: School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK.
authors.forename: Derek
authors.initials: D
authors.lastname: Stewart
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003695:Delivery of Health Care; D019468:Disease Management; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses; D017060:Patient Satisfaction; D010595:Pharmacists; D010820:Physicians; D011320:Primary Health Care; D012017:Referral and Consultation; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D057566:Self Report; D000073278:Self-Management; D011795:Surveys and Questionnaires; D006113:United Kingdom; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: RESPIRATORY MEDICINE (see Thoracic Medicine)