Abstract
BackgroundClinicians prescribe antibiotics to over 65% of adults with acute bronchitis despite guidelines stating that antibiotics are not indicated.MethodsTo identify and understand primary care clinician perceptions about antibiotic prescribing for acute bronchitis, we conducted semi-structured interviews with 13 primary care clinicians in Boston, Massachusetts and used thematic content analysis.ResultsAll the participants agreed with guidelines that antibiotics are not indicated for acute bronchitis and felt that clinicians other than themselves were responsible for overprescribing. Barriers to guideline adherence included 6 themes: (1) perceived patient demand, which was the main barrier, although some clinicians perceived a recent decrease; (2) lack of accountability for antibiotic prescribing; (3) saving time and money; (4) other clinicians’ misconceptions about acute bronchitis; (5) diagnostic uncertainty; and (6) clinician dissatisfaction in failing to meet patient expectations. Strategies to decrease inappropriate antibiotic prescribing included 5 themes: (1) patient educational materials; (2) quality reporting; (3) clinical decision support; (4) use of an over-the-counter prescription pad; and (5) pre-visit triage and education by nurses to prevent visits.ConclusionsClinicians continued to cite patient demand as the main reason for antibiotic prescribing for acute bronchitis, though some clinicians perceived a recent decrease. Clinicians felt that other clinicians were responsible for inappropriate antibiotic prescribing and that better pre-visit triage by nurses could prevent visits and change patients’ expectations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-014-0194-5) contains supplementary material, which is available to authorized users.
Highlights
Over-the-counter prescription pad Domain 1: Contemporary views on acute bronchitis guidelines and antibiotic prescribing The consistent theme that emerged regarding guidelines and antibiotic prescribing for acute bronchitis was that all participants agreed with guidelines stating that antibiotics are not indicated for acute bronchitis and clinicians felt like antibiotics for acute bronchitis were overprescribed by other clinicians, but not by themselves
We conducted qualitative, semi-structured interviews of primary care clinicians to learn about clinicians? understanding about acute bronchitis guidelines, barriers to guideline adherence, and thoughts about interventions to decrease antibiotic prescribing for acute bronchitis
Clinicians perceived that patients continued to have a high level of demand for antibiotics, which remained the largest perceived driver of antibiotic prescribing for acute cough/ acute bronchitis
Summary
Clinicians prescribe antibiotics to over 65% of adults with acute bronchitis despite guidelines stating that antibiotics are not indicated. National guidelines and performance measures, based on randomized controlled trials and meta-analyses, recommend avoiding antibiotic prescribing for patients with acute cough/acute bronchitis [2,3,4,5]. Understanding and attitudes towards antibiotic prescribing for acute bronchitis and other respiratory infections. Most of these studies, summarized in two recent systematic reviews, were performed outside the United States or were published over a decade ago [10,11]. ? 2014 Dempsey et al.; licensee BioMed Central Ltd The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated
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