Abstract
Upper respiratory tract infections (URTIs) account for substantial attendances at emergency departments (EDs). There is a need to elucidate determinants of antibiotic prescribing in time-strapped EDs - popular choices for primary care despite highly accessible primary care clinics. Semi-structured in-depth interviews were conducted with purposively sampled physicians (n = 9) in an adult ED in Singapore. All interviews were analysed using thematic analysis and further interpreted using the Social Ecological Model to explain prescribing determinants. Themes included: (1) reliance on clinical knowledge and judgement, (2) patient-related factors, (3) patient-physician relationship factors, (4) perceived practice norms, (5) policies and treatment guidelines and (6) patient education and awareness. The physicians relied strongly on their clinical knowledge and judgement in managing URTI cases and seldom interfered with their peers' clinical decisions. Despite departmental norms of not prescribing antibiotics for URTIs, physicians would prescribe antibiotics when faced with uncertainty in patients' diagnoses, treating immunocompromised or older patients with comorbidities, and for patients demanding antibiotics, especially under time constraints. Participants had a preference for antibiotic prescribing guidelines based on local epidemiology, but viewed hospital policies on prescribing as a hindrance to clinical judgement. Participants highlighted the need for more public education and awareness on the appropriate use of antibiotics and management of URTIs. Organisational practice norms strongly influenced antibiotic prescribing decisions by physicians, who can be swayed by time pressures and patient demands. Clinical decision support tools, hospital guidelines and patient education targeting at individual, interpersonal and community levels could reduce unnecessary antibiotic use.
Highlights
Upper respiratory tract infections (URTIs) or the common cold are illnesses presenting with acute inflammation of the nasal or pharyngeal mucosa but without other defined respiratory conditions such as streptococcal tonsillitis, pneumonia and asthma [1]
Six key themes emerged as determinants influencing the clinical management of URTI, namely (1) clinical knowledge and judgement, (2) patient-related factors, (3) patient–physician relationship factors, (4) perceived practice norms, (5) policies and treatment guidelines and (6) patient education and awareness
To understand why and when emergency departments (EDs) physicians prescribe antibiotics, it is necessary to understand the interactions between ED physicians and the environments they work in
Summary
Upper respiratory tract infections (URTIs) or the common cold are illnesses presenting with acute inflammation of the nasal or pharyngeal mucosa but without other defined respiratory conditions such as streptococcal tonsillitis, pneumonia and asthma [1]. Excessive and unnecessary use of antibiotics for the treatment of URTIs is prevalent in the USA where over 30% of adults presenting with uncomplicated URTIs and 75% with acute bronchitis were prescribed antibiotics [2,3,4]. Adults had the highest rate of antibiotic use for antibiotic-inappropriate acute respiratory infections (URTIs, influenza and viral pneumonia), with 500 per 1000 visits by adults aged 20– 64 years and 666 per 1000 visits by those aged 65 years or older from 2009–2010 [5]. In the UK, despite clinical guidelines advising against the use of antibiotics for URTIs [6], about 47% were prescribed antibiotics in general practices [7]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
