Including patient preferences and applying guideline recommendations: a conflict?

Abstract

Background One perceived barrier to adherence to guidelines is the existence of patient preferences which may conflict with them. We examined whether patient preferences influence the prescription of antibiotics in general practice, and how this affects adherence to guidelines. We hypothesised that preferences play a greater role in prescribing antibiotics if the guideline allows for patient preferences to be taken into account, i.e. if prescribing antibiotics is an option which can be considered rather than a clear guideline recommendation to prescribe or not. We included three guidelines: acute cough, acute rhinosinusitis, and urinary tract infections. Methods Data from the NIVEL Primary Care Database (NIVEL PCD) were used to assess antibiotic indications and prescriptions. These data were combined with a questionnaire among members of NIVEL’s Dutch Health Care Consumer Panel in order to examine patient preferences. According to the NIVEL PCD, 286 of these members contacted their GP in 2015 for acute cough, acute rhinosinusitis or urinary tract infections. A logistic multilevel regression analysis was performed to test our hypothesis. Results Patient preferences do play a role in GPs’ prescribing of antibiotics but only in situations where in accordance with the guideline their use is an option which could be considered (interaction between indication and preference: p = 0.049). If patients ask for antibiotics themselves in such situations, then GPs prescribe antibiotics more often. Conclusions Patient preferences only play a role if the guideline provides room for these preferences to be taken into account. Therefore, our results do not suggest a conflict between applying guideline recommendations and including patient preferences. Further research is recommended to examine whether this conflict exists in other situations. Key messages •Patient preferences do play a role in GPs’ prescribing of antibiotics but only in situations where in accordance with the guideline their use is an option which could be considered. •Our results do not suggest a conflict between applying guideline recommendations and including patient preferences. Research is recommended to examine whether this conflict exists in other situations. (aut. ref.)