Abstract
ObjectiveTo investigate contemporary patient expectations and experiences of antibiotic prescribing in England.BackgroundPrimary care providers’ compliance with patient influences has been identified as a motivation for antibiotic‐prescribing behaviour. Since 2013, there have been concerted efforts to publicize and address the growing threat of antimicrobial resistance. A fresh qualitative insight into patient expectations and experiences is needed.DesignQualitative study using semi‐structured interviews.Setting and participantsTwo English regions, one an urban metropolitan area and the other a town in rural England. Patients who recently consulted for infections were recruited. The information power approach was used to determine the number of participants, yielding a sample of 31 participants.Main measuresThematic analysis was carried out to analyse the interview data.ResultsFive themes were identified: beliefs, expectations, experiences of taking antibiotic, experience of antimicrobial resistance and side‐effects, and experiences of consultations. The accounts reflected improved public knowledge: antibiotics were perceived to be much‐needed medicines that should be prescribed when appropriate. The data showed that patients formed expectations of expectations, trying to read the prescribers’ intentions and reflect on the dependency between what prescribers and patients wanted. Patient experiences featured as nuanced and detailed with knowledge of AMR and side‐effects of antibiotics in the context of positive consultation experiences.ConclusionsThe study highlighted complex interplays between adherence to antibiotics and consuming antibiotics in reflexive, informed ways. Ensuring that present and future patients are informed about potential benefits and harms of antibiotic use will contribute to future antimicrobial stewardship.
Highlights
Public awareness of antibiotic resistance and the need for more judicious use of antibiotics is increasing, but inappropriate use of antibiotics remains widespread.[1,2] Older studies have ascribed a prominent role to patient influences on antibiotic prescribing, with many studies stressing the view that prescribers may be responsive to patient expectations for antibiotic treatment.[3]
While compliant with antibiotic treatment, participants in our study raised important questions concerning the right antibiotics being prescribed at the right time
A high rate of patients expecting antibiotics can be explained by a high proportion of patients that consulted for urinary tract infections, a recurrent health condition requiring appropriate antibiotic treatment
Summary
Public awareness of antibiotic resistance and the need for more judicious use of antibiotics is increasing, but inappropriate use of antibiotics remains widespread.[1,2] Older studies have ascribed a prominent role to patient influences on antibiotic prescribing, with many studies stressing the view that prescribers may be responsive to patient expectations for antibiotic treatment.[3] This ‘patient influence’ factor has been identified in most systematic reviews[3] Estimates from patient surveys suggest that patients’ positive expectations for antibiotics are substantial but have varied between studies.[4,5,6,7,8,9,10] Family physicians may assume that patients consulting for infections want antibiotics[11] but primary care clinicians can overestimate the extent to which patients are seeking and expecting antibiotic prescriptions,[11,12] especially for parents of young children.[13] There is consistent evidence that GPs are more likely to prescribe antibiotics when their patients are perceived to be expecting them.[8,14,15,16] A systematic review found a generally positive association between physician perceptions of patient expectation and antibiotic prescription,[17] but some studies find evidence of a negative association between expectation and prescription[4] with evidence of inconsistency between physicians’ perceptions and patients’ desire for antibiotics.
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