Managing self-limiting respiratory tract infections: a qualitative study of the usefulness of the delayed prescribing strategy

Authors: Peters, Sarah¹; Rowbotham, Samantha¹; Chisholm, Anna¹; Wearden, Alison¹; Moschogianis, Susie¹; Cordingley, Lis²; Baker, David³; Hyde, Catherine²; Chew-Graham, Carolyn²

Source: British Journal of General Practice, Volume 61, Number 590, September 2011 , pp. e579-e589(11)

Publisher: Royal College of General Practitioners

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Abstract:

Background

Despite respiratory tract infections usually being viral and self-limiting, most primary care consultations still result in an antibiotic prescription. The National Institute for Health and Clinical Excellence (NICE) introduced the `delayed prescribing' (DP) strategy. It remains unknown how useful UK clinicians find this approach

Aim

To investigate how DP is used within UK primary care, and the benefits and challenges associated with this strategy

Design and setting

Qualitative interview and focus group study in UK scheduled and unscheduled care primary care settings

Method

Data were gathered through semi-structured interviews (n = 49) and six focus groups with GPs, trainee GPs, and nurse prescribers (NPs). An iterative analysis approach, using grounded theory principles, was used to generate themes from the dataset.

Results

Prescribers were familiarwith DP but used it infrequently. DP was often used to manage diagnostic uncertainty, although NPs, trainee GPs, and GPs working in unscheduled care services preferred patients to reconsult under these circumstances. Prescribers used DP to avoid conflict, although some had found more effective strategies to achieve this. Prescribers were generally uncomfortable giving clinical responsibility to patients, and DP was perceived to communicate a conflicting message to patients about antibiotic efficacy.

Conclusion

DP was not considered to be a helpful strategy for managing patients with self-limiting respiratory tract infections within primary care and the findings do not support the centrality of DP in NICE guidelines as a primary means of reducing antibiotic prescribing. Future training and guidelines should encourage alternative ways of communicating empathy, addressing patient beliefs, and encouraging self-management.

Keywords: antibacterial agents; drug prescriptions; health communication; primary care; qualitative research

Document Type: Research article

DOI: http://dx.doi.org/10.3399/bjgp11X593866

Affiliations: 1: School of Psychological Sciences, University of Manchester, Manchester 2: School of Community Based Medicine, University of Manchester, Manchester 3: North Western Deanery, Manchester

Publication date: 2011-09-01

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The British Journal of General Practice is an international journal publishing articles of interest to family practitioners and primary care researchers worldwide. The journal's 2010 Impact Factor is 2.07, making it the world's second most highly cited journal of general practice and primary health care.

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Managing self-limiting respiratory tract infections: a qualitative study of the usefulness of the delayed prescribing strategy

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