Perspectives Of Family Physicians Research Articles

Impact of the COVID-19 pandemic on medical office assistants (MOAs) Working in Primary Care: A Qualitative Study.

Medical Office Assistants (MOAs), also known as receptionists and clerks, are front line workers and the most accessible member of the primary care team. Historically, their contributions to primary care have been unrecognised and undervalued. The COVID-19 pandemic put pressure on existing roles and systems in primary care: how MOAs adapted is unknown. To explore the experiences of MOAs working in primary care during the COVID-19 pandemic from the perspectives of MOAs and family physicians (FPs) who worked with MOAs during this period. A qualitative study using Constructivist Grounded Theory, conducted in Ontario, Canada METHOD: Seventeen participants were recruited through professional contacts of the research team. Individual semi-structured interviews were conducted with MOAs and FPs across the province. MOAs' many responsibilities in primary care intensified during the pandemic. MOAs leveraged their healthcare system knowledge and therapeutic relationships with patients to reduce patient distress. Unfortunately, MOAs experienced more frustration, and in some cases, abuse from patients. MOAs' ability to adapt to new systems and respond to high patient needs seemed to be positively influenced by their relationships with patients and FPs. FPs expressed concern for MOA welfare and recognised their critical role on primary care teams. MOAs made significant contributions to primary care during the COVID-19 pandemic. This study suggests MOAs have greater capacity than previously recognised which has important implications for planning in an era of under-resourced healthcare.

Perspectives of Turkish family physicians towards refugee patients and primary health care: A qualitative study

Perspectives of Turkish family physicians towards refugee patients and primary health care: A qualitative study

Advancing Indigenous primary health care research and education capacity: a qualitative study in Alberta, Canada

Background/Purpose The study explores the perspectives of family physicians in Alberta regarding Indigenous health research education within the framework of primary health care (PHC). Recognizing the key role of PHC in healthcare system, the research identified the preferences and needs of family physicians for relevant and accessible research skills education. To design effective research education, it is critical to understand the skills, content, and delivery methods desired by family physicians engaged in Indigenous health research. The Indigenous Primary Health Care and Policy Research (IPHCPR) Network is examined as a potential transformative platform aligned with Truth and Reconciliation Commission principles and Calls to Action. Methods Through purposive sampling, 12 family physicians practicing in Alberta were recruited to participate in semi-structured qualitative interviews . The study utilized a thematic content approach for data analysis. Results Four key themes emerged from the analysis: 1) Indigenous role modeling; 2) cohort-based learning; 3) relational learning; and 4) the epistemic importance of Indigenous perspectives on learning. Participants emphasized the need for mentorship, collaborative learning settings, and meaningful connections within a research network. Discussion The IPHCPR Network stands out as a pivotal platform for transformative change in healthcare research education, offering opportunities for family physicians, researchers, trainees, and communities to collaboratively improve Indigenous health outcomes. Through its inclusive practices, the network aligns with TRC principles to advance Indigenous health equity and addressing critical gaps in Indigenous primary health research and practice.

When and What: Family Physicians' Perspective on Clinical Communication Skills and Professionalism Education during the Medical Training Program in Riyadh, Saudi Arabia

Background: Effective communication skills are crucial for health professionals in order to build a favorable rapport with their patients, so enhancing their overall well-being and quality of life. From this standpoint, the implementation of communication skills training may serve as effective techniques to enhance the care delivered by healthcare personnel and the overall quality of healthcare services. Aim: To investigate the perspectives of family physicians, on the necessary communication and professionalism skills for medical students, as well as the best time during medical training programs to attain these competencies in Riyadh, Saudi Arabia. Methods: A cross-sectional survey-based study was conducted among family medicine physicians in different hospitals, Riyadh, Saudi Arabia. Participants responded to inquiries on the communication abilities and professionalism competencies while discussing the timing of competency achievement. An online questionnaire was sent to all the physicians. The questionnaire consisted of three sections: Gathering demographic information, Questionnaire on professional engagements, and a timeline estimation of each doctor's acquisition of communication skills and professionalism competencies. The data analysis was performed using SPSS, Version 26.0. Prior to analysis, data cleaning and entering were conducted. A test is considered significant if the P-value is below 0.05. Results: A total of 301 participants, aged between 30 and 41 years old, took part in the current research. Approximately 51.5% of the participants were family physician specialists, whereas around 25.9% were residents and 4% were students. A majority of FM respondents (56.5%) said that FM residency is the most opportune period in the medical training program to include the bio-psycho-social context. Respondents (50.5%) felt that it is during this time that they get a better understanding of the patient's viewpoint and that of their family. Approximately 48.5% of FM participants believe that the FM residency is the most favorable period of medical training to take into account the beliefs, needs, and perspectives of patients and their families. However, 58.5% of participants feel that this residency provides an opportunity to develop strong critical thinking skills. Furthermore, 50.2% of participants believe that the FM residency equips them with the ability to handle uncertainty effectively and adapt to various situations and contexts. The majority of FM participants were doing clinical activities at different stages; After Residency (93.8%), Residency (80.8%), or Undergraduate (86.8%). In addition, teaching practice was significantly related to the stages of communication training (P<0.001); most of FM participants practice teaching after Residency (90.6%), and 53% of them practice teaching in their Residency. there is a significant relation between the clinical activity done and the stage of professionalism training (P=0.005), the majority of FM participants were doing clinical activities at different stages; After Residency (93.9%), Residency (83.6%), or Undergraduate (76.3%). In addition, the preceptor was significantly related to the stages of professionalismtraining (P=0.010); 45.5% of FM participants after residency were preceptors. Conclusion: The perspectives of these family doctors' medical educators may aid in formulating the necessary objectives for medical training, which might influence the structure of medical curricula and promote lifelong learning initiatives. Future research should focus on certifying these key competencies and enhancing evaluation methodologies, with a particular emphasis on evaluating their effect on healthcare. Keywords: Family Physicians, Perspectives, Clinical Communication Skills, Professionalism, Medical Training

Early career family physician perspectives on their residency experience and practice choices in Canada: a qualitative study

Background: Though there are more family physicians in Canada than ever before, and residency programs are expanding, gaps in access to comprehensive care remain. This study aimed to describe and understand the role residency training experiences played in shaping practice choices, including the provision of comprehensive community-based care, among early career family physicians. Methods: A secondary analysis of sixty-three (63) qualitative interviews was conducted on data from a larger mixed method study on practice patterns and choices of early career Canadian family physicians. We utilized Braun and Clarke’s six phases of reflexive thematic analysis on portions of transcripts concerning residency training experiences. Results: Participants described positive residency training experiences that shaped practice choice with respect to preceptors and mentorship, experiences of longitudinal care, breadth of exposure, and preparedness for comprehensive clinical practice. Woven through these four domains were “points of tension” and “hidden truths”. Points of tension included: i) the promotion of an idealized professional identity and practice that was difficult to uphold, ii) lack of representation among faculty/preceptors with respect to age and gender, at some sites, and iii) frustration about the lack of opportunities for interprofessional collaborative practices that reflected training experiences. Hidden truths included: i) lack of preparation to run a business, ii) high administrative workload, iii) realities of payment models, and iv) the range of roles available for family physicians beyond the provision of comprehensive care. Conclusions: Findings highlight opportunities for educational reform supporting the transition from residency to practice alongside the importance of addressing systemic factors beyond training which impact physicians’ choices regarding comprehensive care.

"Technology has allowed us to do a lot more but it's not necessarily the panacea for everybody": Family physician perspectives on virtual care during the COVID-19 pandemic and beyond.

Early in the COVID-19 pandemic, Canadian primary care practices rapidly adapted to provide care virtually. Most family physicians lacked prior training or expertise with virtual care. In the absence of formal guidance, they made individual decisions about in-person versus remote care based on clinical judgement, their longitudinal relationships with patients, and personal risk assessments. Our objective was to explore Canadian family physicians' perspectives on the strengths and limitations of virtual care implementation for their patient populations during the COVID-19 pandemic and implications for the integration of virtual care into broader primary care practice. We conducted semi-structured qualitative interviews with family physicians working in four Canadian jurisdictions (Vancouver Coastal health region, British Columbia; Southwestern Ontario; the province of Nova Scotia; and Eastern Health region, Newfoundland and Labrador). We analyzed interview data using a structured applied thematic approach. We interviewed 68 family physicians and identified four distinct themes during our analysis related to experiences with and perspectives on virtual care: (1) changes in access to primary care; (2) quality and efficacy of care provided virtually; (3) patient and provider comfort with virtual modalities; and (4) necessary supports for virtual care moving forward. The move to virtual care enhanced access to care for select patients and was helpful for family physicians to better manage their panels. However, virtual care also created access challenges for some patients (e.g., people who are underhoused or living in areas without good phone or internet access) and for some types of care (e.g., care that required access to medical devices). Family physicians are optimistic about the ongoing integration of virtual care into broader primary care delivery, but guidance, regulations, and infrastructure investments are needed to ensure equitable access and to maximize quality of care.

Barriers to research in family medicine-interviews with Portuguese family physician researchers.

There is a need for a deeper understanding of the barriers to research in family medicine (FM) and to consider the perceptions and perspectives of professionals. Our study aims to provide a strategic view for research capacity building in FM. We included the perspective of family physician researchers (FPR) on the existing barriers to investigation in this context. To understand and characterize the barriers to research in FM (personal and structural), from the perspective of Portuguese family physicians who are researchers. A qualitative study, of phenomenological nature, was performed, through the conduction of semi-structured interviews with FPR, from 2019 to 2022. Data analysis and thematic coding were done on MAxQDA®, with inductive and deductive approaches, until data saturation was reached. A total of 12 family physicians/researchers were interviewed. Seven main themes were identified as barriers to research: time, professional valorization, funding, ethics committees, infrastructure, management/institutions, and participants. Each theme is divided into subthemes that make it possible to assess how a barrier can affect researchers in performing research activities. Our study highlights the identification of 7 main barriers. Structuring them into sub-themes not only improved the organization of our results but also provided robust support for the next phase, namely the application of a survey with the aim of gaining a deeper insight into the repercussions that these barriers to FPR have at a national level. This research is crucial to laying the foundations for a policy document that offers well-defined and tailored recommendations to address the barriers we have uncovered.

Conceptualizing "Preparedness for Practice": Perspectives of Early-Career Family Physicians.

Competency based medical education (CBME) aims to produce graduates prepared for independent practice. Many equate the outcome of "preparedness for practice" with acquisition of competence. As educators evaluate the outcomes of CBME, being clear on the concept of preparedness for practice will clarify the results that are measured and assessed. This study examined how preparedness for practice is conceptualized in the literature and by family physicians (FPs) in Canada. This multimethod qualitative descriptive study included (1) rapid review and narrative synthesis, and (2) focus groups with early-career FPs using maximum variation sampling until thematic saturation was reached. Focus groups explored the FPs' conceptualizations of preparedness for practice. Focus groups were audio-recorded, transcribed, and coded before content analysis. Thirty-four articles met the inclusion criteria, and 59 early-career FPs participated in the focus groups. We found no consensus on the conceptualization of preparedness for practice in the literature; however, the concept often was described as acquiring competencies for program requirements. In the literature and focus groups, we identified four themes for the conceptualization of preparedness for practice. These themes included competence, self-confidence (self-efficacy, self-concept), capability, and adaptability. Preparedness for practice involves an interplay of dynamic and complex constructs from competence, self-confidence, capability, and adaptability. Preparedness is more than possessing several competencies; it calls for integrating and applying competencies in complex and changing environments. This study aimed to start a discussion on what end point is desirable for residency education and proposed that the end point needs to move beyond competencies.

Understanding the influence of medical education on physician geographic disposition: A qualitative study of family physician perspectives in Canada

AbstractRationalePrimary care access challenges are experienced by many communities. In several jurisdictions, including Canada, family physicians (FP) have the professional autonomy to organize their practice in alignment with professional and personal interests. Although system‐level interventions are tremendously important, investment in upstream interventions associated with the medical education of graduating FPs is a promising strategy for ameliorating primary healthcare access challenges.Aims and ObjectivesThis study investigates the medical education experiences that influence FP's decisions about practice locations in Canada.MethodsWe conducted semistructured interviews with FPs who completed undergraduate and postgraduate medical training in Canada and now have a practice in Ontario, Canada. Interview data were coded and analysed using an unconstrained descriptive approach.ResultsFPs preferred practice locations are intimately tied to their desired practice scope. Practice preferences were shaped through training experiences with patient populations, heightened clinical responsibilities, practice models and locations, professional mentorships and networks. Proximity to family, partner and lifestyle preferences, cultural connections and the available practice opportunities also shaped practice location decisions.ConclusionMedical education influences the identification and refinement of professional family practice preferences. Health workforce policies and interventions should leverage medical education to promote more equitable primary healthcare access.

The Certificate of Added Competence credentialling program in family medicine: a descriptive survey of the family physician perspective of enhanced skill practices in Canada.

The College of Family Physicians of Canada (CFPC) offers the Certificate of Added Competence (CAC) program to designate a family physician with enhanced skills. In 2015, the College expanded its program to introduce enhanced certification in four new domains: Palliative Care, Care of the Elderly, Sports and Exercise Medicine, and Family Practice Anesthesia. In this study, we elicited perceptions from Canadian family physicians with and without the CAC on practice impacts associated with the program. Active family physicians in Canada with and without CACs were surveyed between November 2019 to January 2020. Descriptive statistics were generated to describe the perceptions of family physicians regarding the CAC program and its impacts on practice. Respondents agreed with several benefits of the program including enhancing the capacity to deliver comprehensive care, alleviating the burden of patient travel by increasing the availability of care in rural and remote communities, and providing opportunities to engage in various collaborative care models and new leadership roles. All respondents perceived CAC holders to pursue the certificate to meet both professional interests and community needs. There is a need for strong and continued investment in systemic practice improvements that incentivize the delivery of comprehensive family medicine practice.

Exploring Family Physician Training Needs to Improve Cancer Patient Care.

Family physicians have multifaceted roles in cancer patient care and oncology education among this group is unfortunately inadequate. This study explored the needs and perspectives of family physicians regarding their oncology training and experiences. As well, physician cancer care experiences, knowledge use, and continuing education practices were elucidated. The authors employed a qualitative approach with family physicians participating in semi-structured interviews. General practitioners in oncology were excluded. Purposeful sampling was used, with recruitment through Ontario regional primary cancer care leads and social media. Interviews were transcribed, and thematic analysis was conducted. Thirteen participants were interviewed-1.6:1 female: male, ages 30-39, practicing for an average of 9 years (0.5-30 years), with urban and suburban practices. Most trained in Canada as undergraduates and completed their residency in Ontario; 62% had participated in at least one oncology continuing medical education session. Three major themes emerged: delineation of roles, oncology knowledge and education, and palliative care. Participants reported role uncertainty after cancer diagnosis, with oncology teaching at all levels described as lacking relevance. Palliative care rotations were an avenue for oncology education and where participants returned to cancer care. Changing existing teaching, information access, and avenues of oncology experiences may be the next step to supporting successful cancer care by family physicians.

Traditional and complementary medicine perspectives of family physicians in Istanbul

Introduction: The World Health Organization, within the scope of the Traditional Medicine Strategy for 2014-2023, recommends the development of integrated health policies, particularly in the area of primary healthcare. However, family physicians often report feeling insufficiently trained to effectively integrate these practices into patient care. This study aims to assess the views, understanding, and experiences of family physicians regarding the utilization of Traditional & Complementary Medicine (T&CM).Methods: The family physicians employed by the Istanbul Health Directorate Public Health Services were solicited to participate in an 18-question online survey to assess their level of education in T&CM methods, their views on integration of T&CM into family medicine, and the impact of these practices on patient care.Results: A total of 324 family physicians took part in the survey; 12.0% were specialists, 64.5% had worked in primary care for over 10 years, and 59.6% were in the age range of 31-50 years. Among the physicians, the majority (70.1%) reported a preference for integrating T&CM practices with conventional medicine (ConvM). The majority of the participants (71.6%) had no formal T&CM training, and 66.4% reported inquiring about T&CM in their patient consultations. Over half of the physicians (56.79%) believed that T&CM methods should be used in preventive medicine. The most widely recognized T&CM technique was cupping therapy (18.5%), which was also the most frequently recommended method by physicians.Conclusion: Most of the family physicians who participated in the study expressed a desire for integrative medicine, despite acknowledging limited formal education in this field. Offering physicians training in evidence-based complementary medicine therapies could provide them with additional non-invasive treatment options. However, patients' diffidence to inform their family physicians about T&CM practices they undergo may pose significant risks. As a result, incorporating education on integrative medicine into formal medical education and residency training may be necessary.Keywords: Family physician, complementary medicine, integrative medicine, traditional medicine

Family Physician Prescribing Practices and Perspectives on Shared Decision-Making Regarding the Use of Oral Anticoagulants for Stroke Prevention in Patients 75 Years or Older With Atrial Fibrillation.

Atrial Fibrillation (AF) is common in older adults, yet guideline-recommended oral anti-coagulants (OACs) for stroke prevention are underused in this population. With a growing population of older adults at risk of AF seeking primary care, the objective of the study was to determine the management practices and perspectives of family physicians on the initiation of OACs for stroke prevention in AF patients 75 years or older, including their engagement of patients in shared decision-making. This was an online survey of family physicians affiliated with a Primary Care Network in Alberta, Canada. Patient's risk (of falls, bleeding, or stroke) was the most common factor (17/20, 85%) physicians considered when deciding to initiate OAC in older adult patients with AF. Physicians used the CHADS2VASC (13/14, 93%) and HASBLED (11/15, 73%) tools to determine stroke and bleeding risks, respectively. Majority (11/15, 73%) of the physicians agreed that they feel confident initiating OAC for AF patients ≥75, while 20% (3/15) were neutral. All physicians agreed that their patients participated in shared decision-making to initiate OAC for stroke prevention. Family physicians strongly consider patient risks and utilize risk-assessment tools when initiating OAC in older adults with AF. Despite all physicians reporting the use of shared decision-making and that their patients were educated on the indications for OAC, confidence in initiating treatment was variable. Further exploration into factors impacting physician confidence is needed.

Improving Primary Healthcare Access for Asylum Seekers and Refugees: A Qualitative Study From a Swiss Family Physician Perspective.

Since 2015 the need for evidence-based guidance in primary health care management of refugees, asylum seekers, and immigrants has dramatically increased. The aims of this study were to identify the challenges met by primary care physicians in Switzerland, by performing semi-structured interviews and to identify possible approaches and interventions. Between January 2019 and January 2020, 20 GPs in 3 Swiss cantons were interviewed. The interviews were transcribed, coded with MAXQDA 18, and analyzed using the framework methodology. Following relevant findings were highlighted; (i) problems relating to health insurance companies among (health-insured) asylum seekers and refugees were negligible; (ii) there is a high acceptance for vaccination by refugees, asylum seekers, and immigrants; (iii) limitations in time for consultations and adequate reimbursement for practitioners pose a serious challenge; (iv) the majority of consultations are complaint-oriented, preventive consultations are rare; and (v) the language barrier is a major challenge for psychosocial consultations, whereas this appears less relevant for somatic complaints. The following issues were identified as high priority needs by the study participants; (i) increased networking between GPs, that is, establishing bridging services with asylum centers, (ii) improved training opportunities for GPs in Migration Medicine with regular updates of current guidelines, and (iii) a standardisation of health documentation facilitating exchange of medical data, that is, digital/paper-based "health booklet" or "health pass."

Ontario family physicians' perspectives about their scope of practice: what is it, what drives it and how does it change?

BackgroundThere is little evidence to show what scope of practice (SOP) means from the point of view of family physicians, how family physicians think about their SOP as it changes over time, or what factors shape and influence their SOP. Understanding family physician perspectives on SOP and the factors that influence it can aid our understanding of how it can constrain and enable physicians’ agency and autonomy in professional practice.MethodsUsing qualitative description and incorporating constructivist grounded theory data collection and analysis techniques, four focus groups were conducted involving twenty-four Ontario-based family physicians from different contexts, at different career stages, and with different practice experiences.ResultsParticipants’ SOP was highly dynamic, changing throughout their careers due to factors both within and beyond their control. Their sense of their own SOP was the product of a continuous cycle of personal and professional transitions, exposures, and experiences throughout their careers. These family physicians sought regular and sustained mentorship, support, and engagement for their SOP throughout their careers. This was particularly the case during professional transitions and for drivers of their SOP for which they felt unprepared early in their careers, such as through the first years of independent practice, and when functioning as owner-operators of medical practices. Four descriptive themes were identified focusing on the nature of their current practice, their professional preparedness and supports, practice management dynamics, and ‘doctors are people, too’.ConclusionsThe SOP of the family physicians in this study was dynamic and unique to each individual, it emerged from interactions between their personal and professional lives and identities, and it was embedded in their lived experiences. SOP was also to some extent imposed and externally driven. This study advances understanding by exploring the ‘why’ and ‘how’ of SOP rather than focusing solely on what it is.

Asian perspectives on NAPCRG

This is a short communication to reflect on experiences at North American Primary Care Research Group (NAPCRG) conference from the perspective of Asian family physicians. They feel that NAPCRG can...

Rural Family Physician Perspectives on Wellness and the Role of Training in Supporting Physician Wellness.

Research evaluating the well-being of rural family physicians is limited, resulting in minimal understanding of how to prepare family medicine residents to succeed in rural practice postresidency. Our study aimed to investigate factors associated with maintaining wellness within rural family medicine practices and highlight interventions that rural family physicians identify as important to promote wellness among those seeking future employment in rural settings postresidency. Forty-eight rural family physicians completed an online survey with qualitative and multiple-choice items including the Mini-Z about physician demographics, burnout, and wellness. We conducted data analysis using NVivo 12 software for qualitative analyses and R 3.6.1 software for descriptive statistics. The majority of participants reportedly maintained wellness in rural family practice (maintenance of wellness=79.17%; denied burnout=62.26%). Burnout rates were similar to the national burnout rates for family physicians (37.74% vs 46%). Participants identified multiple residency interventions that could be implemented to prepare rural family physicians to succeed. This study highlights factors that are associated with the maintenance of wellness among rural family physicians. This is the first study to investigate rural family physician perspectives on residency interventions that may have positive outcomes on wellness postresidency.

Physician Perspectives on the Implementation of a Trauma Informed Care Initiative in the Maternity Care Setting

Objectives: To explore the barriers and facilitators from the perspective of family physicians on the implementation of a pilot trauma-informed care (TIC) initiative to promote resilience, with particular emphasis on asking about adverse childhood experiences (ACEs), in a maternity care clinic.Methods: Using an exploratory qualitative design, in-depth semi-structured interviews were conducted with family physicians who were practicing in a maternity clinic in a large Canadian city. Interviews were audio-recorded and transcribed verbatim. Transcripts were reviewed by three coders and themes were extracted using thematic analysis.Results: The analysis of 10 interviews yielded six thematic domains. Three domains pertained to perceived barriers to obtaining an ACEs history including: (1) concern about time management, (2) initial lack of physician comfort with TIC, and (3) cultural limitations of using the ACEs questionnaire. Three themes pertained to perceived facilitators of obtaining an ACEs history including: (1) the importance of a physician champion, (2) a supportive and flexible clinic environment, and (3) improved patient-physician relationships.Implications: In the context of a broader TIC initiative within a maternity care setting, asking patients about ACEs was generally perceived positively by physicians. Ensuring a supportive clinic environment and adequate staff training may be critical factors that contribute to successful implementation. Future research focused on diverse physician experiences in different settings are needed.

Evaluating a physicians' perspective on the use of probiotics and vitamins against coronavirus disease.

To evaluate the perspective of family physicians on probiotics and vitamins against coronavirus disease-2019. The cross-sectional study was conducted from June 1 to 30, 2021, after approval from the ethics review committee of Bursa Uludag University, Bursa, Turkey, and comprised family physicians of either gender working at family health centres in the country. Data was collected using an online questionnaire to measure the sociodemographic characteristics, habits, health status related to coronavirus disease-2019, and their knowledge, awareness and behaviour towards the use of probiotics and vitamins during the pandemic. Data was analysed using SPSS 25. Of the 218 family physicians, 130(59.6%) were male and 88(40.4%) were female. The overall mean age was 46.82±5.85 years, mean professional experience was 22.32±8.75 years, and mean experience in family medicine was 10.14±3.51 years. The knowledge and awareness level about coronavirus disease-2019 was high 4.18±0.58, exposure to the disease 3.36±0.83 and their inclination towards the use of vitamins and probiotics 1.68±0.75 was low. Among the participants, 90(41.3%) used probiotic products and 120(55%) used drugs, such as vitamins and minerals. Vitamin C 99(45.4%) was the most commonly used supplement. Physicians' knowledge and awareness and a realistic scientific approach are important when recommending supplements, such as probiotics, vitamins and minerals, to individuals during the pandemic.

Coping with ‘the grey area’ of antibiotic prescribing: a theory-informed qualitative study exploring family physician perspectives on antibiotic prescribing

BackgroundUnnecessary antibiotic use is associated with adverse side effects and rising rates of resistance at the individual and population level. This study used a theory-informed approach to identify potentially modifiable determinants of antibiotic prescribing for patients presenting to primary care with upper respiratory tract infection symptoms.MethodsQualitative interviews were conducted with primary care physicians in Ontario, Canada who were identified as medium- or high-volume antibiotic prescribers (high volume defined as top 20th percentile versus “medium” defined as 40th to 60th percentile). The interview guide and analysis were informed by the Theoretical Domains Framework. Each interview was coded by two research team members. Sampling and analysis continued until thematic saturation was achieved.ResultsTwenty family physicians were interviewed. Physicians felt that many decisions about prescribing for upper respiratory tract infection symptoms were straightforward (i.e., black and white). However, intention to avoid prescribing in cases where an antibiotic was not indicated clinically did not always align with the provider action or expectation of the patient. Clinical decisions were influenced by the Theoretical Domain Framework domains that were both internal to the physician (Knowledge, Skills, Social/Professional Role, and Belief about Capabilities) and external to the physician (Social Influence, Belief about Consequences, Reinforcement, Emotions, and Behavioural Regulation). The Environmental Context and Resources played a key role. Physicians reported significant differences in their approach to antibiotic prescribing within episodic (walk-in) or continuity of care settings, as the presence (or not) of longitudinal physician–patient relationships seemed to moderate the role of these factors on the decision-making process in cases of uncertainty.ConclusionsAntibiotic prescribing in primary care is a complex decision-making process in which context may outweigh biology during encounters featuring clinical uncertainty. Differential skill in handling uncertainty and tactics used to operationalize guideline recommendations in the real world seems to contribute to observed variation in prescribing patterns, as much or more than differences in knowledge of best practices.