Abstract
BackgroundPrescribing of antibiotics for common infections varies widely, and there is no medical explanation. Systematic reviews have highlighted factors that may influence antibiotic prescribing and that this is a complex process. It is unclear how factors interact and how the primary care organization affects diagnostic procedures and antibiotic prescribing. Therefore, we sought to explore and understand interactions between factors influencing antibiotic prescribing for respiratory tract infections in primary care.MethodsOur mixed methods design was guided by the Triangulation Design Model according to Creswell. Quantitative and qualitative data were collected in parallel. Quantitative data were collected by prescription statistics, questionnaires to patients, and general practitioners’ audit registrations. Qualitative data were collected through observations and semi-structured interviews.ResultsFrom the analysis of the data from the different sources an overall theme emerged: A common practice in the primary health care centre is crucial for low antibiotic prescribing in line with guidelines. Several factors contribute to a common practice, such as promoting management and leadership, internalized guidelines including inter-professional discussions, the general practitioner’s diagnostic process, nurse triage, and patient expectation. These factors were closely related and influenced each other. The results showed that knowledge must be internalized and guidelines need to be normative for the group as well as for every individual.ConclusionsLow prescribing is associated with adapted and transformed guidelines within all staff, not only general practitioners. Nurses’ triage and self-care advice played an important role. Encouragement from the management level stimulated inter-professional discussions about antibiotic prescribing. Informal opinion moulders talking about antibiotic prescribing was supported by the managers. Finally, continuous professional development activities were encouraged for up-to-date knowledge.
Highlights
Prescribing of antibiotics for common infections varies widely, and there is no medical explanation
The overall theme that characterized Primary Health Care Centre (PHCC) with low prescribing of antibiotics was A common practice in line with guidelines (Fig. 2)
We identified five main factors of importance for antibiotic prescribing for Respiratory Tract Infection (RTI) in primary health care: Promoting management and leadership – facilitating structure, Local processing – Internalization of guidelines, General Practitioner (GP)’s diagnostic process, Standardized Nurse Triage, and Patient expectation (Table 3)
Summary
Prescribing of antibiotics for common infections varies widely, and there is no medical explanation. Systematic reviews have highlighted factors that may influence antibiotic prescribing and that this is a complex process It is unclear how factors interact and how the primary care organization affects diagnostic procedures and antibiotic prescribing. We sought to explore and understand interactions between factors influencing antibiotic prescribing for respiratory tract infections in primary care. In Sweden the prescribing, especially for respiratory tract infections (RTIs), varies among counties [2], between different primary health care centres (PHCCs) [3], and between individual doctors [4], but there is no medical explanation for the variation [5]. The guidelines have been disseminated through mailings to the health centres, articles in the Swedish Medical Journal, presentations at national and local meetings and through out-reach visits to the health centres by members of the local Strama groups in each of the 21 counties
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