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"I'm Dr Jekyll and Mr Hyde": are GPs' antibiotic prescribing patterns contextually dependent? A qualitative focus group study.

Strandberg EL, Brorsson A, Hagstam C, Troein M, Hedin K - Scand J Prim Health Care (2013)

Bottom Line: The decision to prescribe antibiotics takes place in the encounter between GP and patient, initially characterized by harmony or fight and the subsequent process by collaboration or negotiation, resulting in agreement, compromise, or disagreement.Continuity and mutual trust can make a brief consultation successful, but lack of continuity can eliminate the effects of knowledge and professional skills.Furthermore, the importance of an appropriate organization of primary care, which promotes continuity and encourages professional autonomy, is demonstrated.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Sciences, Lund University, Malmö, Sweden. eva-lena.strandberg@med.lu.se

ABSTRACT

Objective: To explore factors and circumstances contributing to prudent antibiotic prescribing for respiratory tract infections in primary care.

Design: Two focus groups representing rural and urban areas. A semi-structured interview guide with open-ended questions and an editing analysis style was used. They were examined to identify meaning units that were sorted into categories in an iterative process throughout the analysis.

Setting: Primary health care in two counties in southern Sweden.

Subjects: Two groups including seven and six general practitioners (GPs) respectively, men and women of different ages with different professional experiences.

Main outcome measures: Exploration of categories, determination of themes, construction of models.

Results: The decision to prescribe antibiotics takes place in the encounter between GP and patient, initially characterized by harmony or fight and the subsequent process by collaboration or negotiation, resulting in agreement, compromise, or disagreement. Several factors influence the meeting and contribute to enhancing the conditions for rational prescribing. These conditions are connected to the GP, the relationship, and the setting; organization as well as professional culture. The findings indicate synergies between the factors, and that one factor can sometimes compensate for lack of another. Continuity and mutual trust can make a brief consultation successful, but lack of continuity can eliminate the effects of knowledge and professional skills.

Conclusions: The findings emphasize the importance of the encounter between the GP and the patient for prudent antibiotic prescribing. Furthermore, the importance of an appropriate organization of primary care, which promotes continuity and encourages professional autonomy, is demonstrated.

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Related in: MedlinePlus

Factors influencing the encounter between the GP and the patient.
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Figure 2: Factors influencing the encounter between the GP and the patient.

Mentions: We found that the most significant and important factor concerning antibiotic prescribing for RTIs is what happens when the GP meets the patient (Table II). Our main finding concerns two dimensions of this encounter: characteristics of the meeting depending on the interaction with the patient (Figure 1) and influencing factors (Figure 2).


"I'm Dr Jekyll and Mr Hyde": are GPs' antibiotic prescribing patterns contextually dependent? A qualitative focus group study.

Strandberg EL, Brorsson A, Hagstam C, Troein M, Hedin K - Scand J Prim Health Care (2013)

Factors influencing the encounter between the GP and the patient.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750438&req=5

Figure 2: Factors influencing the encounter between the GP and the patient.
Mentions: We found that the most significant and important factor concerning antibiotic prescribing for RTIs is what happens when the GP meets the patient (Table II). Our main finding concerns two dimensions of this encounter: characteristics of the meeting depending on the interaction with the patient (Figure 1) and influencing factors (Figure 2).

Bottom Line: The decision to prescribe antibiotics takes place in the encounter between GP and patient, initially characterized by harmony or fight and the subsequent process by collaboration or negotiation, resulting in agreement, compromise, or disagreement.Continuity and mutual trust can make a brief consultation successful, but lack of continuity can eliminate the effects of knowledge and professional skills.Furthermore, the importance of an appropriate organization of primary care, which promotes continuity and encourages professional autonomy, is demonstrated.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Sciences, Lund University, Malmö, Sweden. eva-lena.strandberg@med.lu.se

ABSTRACT

Objective: To explore factors and circumstances contributing to prudent antibiotic prescribing for respiratory tract infections in primary care.

Design: Two focus groups representing rural and urban areas. A semi-structured interview guide with open-ended questions and an editing analysis style was used. They were examined to identify meaning units that were sorted into categories in an iterative process throughout the analysis.

Setting: Primary health care in two counties in southern Sweden.

Subjects: Two groups including seven and six general practitioners (GPs) respectively, men and women of different ages with different professional experiences.

Main outcome measures: Exploration of categories, determination of themes, construction of models.

Results: The decision to prescribe antibiotics takes place in the encounter between GP and patient, initially characterized by harmony or fight and the subsequent process by collaboration or negotiation, resulting in agreement, compromise, or disagreement. Several factors influence the meeting and contribute to enhancing the conditions for rational prescribing. These conditions are connected to the GP, the relationship, and the setting; organization as well as professional culture. The findings indicate synergies between the factors, and that one factor can sometimes compensate for lack of another. Continuity and mutual trust can make a brief consultation successful, but lack of continuity can eliminate the effects of knowledge and professional skills.

Conclusions: The findings emphasize the importance of the encounter between the GP and the patient for prudent antibiotic prescribing. Furthermore, the importance of an appropriate organization of primary care, which promotes continuity and encourages professional autonomy, is demonstrated.

Show MeSH
Related in: MedlinePlus