Primary care clinicians’ perceptions about antibiotic prescribing for acute bronchitis: a qualitative study

BMC Family Practice

Research Article

Alexandra C Businger¹  Patrick P Dempsey¹  Jeffrey A Linder²  Lauren E Whaley³  Joshua J Gagne⁴ 

[1] Division of General Medicine and Primary Care, Brigham and Women’s Hospital, 1620 Tremont Street, 02120, Boston, MA, USA;Division of General Medicine and Primary Care, Brigham and Women’s Hospital, 1620 Tremont Street, 02120, Boston, MA, USA;Harvard Medical School, Boston, MA, USA;Massachusetts Department of Public Health, Bureau of Infectious Diseases, Boston, MA, USA;Survey and Data Management Core, Dana Farber Cancer Institute, Boston, MA, USA;

关键词: Bronchitis;    Respiratory tract infections;    Anti-bacterial agents;    Primary health care;    Qualitative research;   

DOI  :  10.1186/s12875-014-0194-5

 received in 2014-08-20, accepted in 2014-11-12,  发布年份 2014

来源: Springer

【 摘 要 】

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.

【 授权许可】

Unknown   
© Dempsey et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. 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.