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Interacting factors associated with Low antibiotic prescribing for respiratory tract infections in primary health care - A mixed methods study in Sweden

Strandberg, Eva Lena LU ; Brorsson, Annika LU ; André, Malin; Gröndal, Hedvig; Mölstad, Sigvard LU and Hedin, Katarina LU (2016) In BMC Family Practice 17(1).
Abstract

Background: Prescribing of antibiotics for common infections varies widely, and there is no medical explanation. Systematic reviews have highlighted factors that may influence antibiotic prescribing and that this is a complex process. It is unclear how factors interact and how the primary care organization affects diagnostic procedures and antibiotic prescribing. Therefore, we sought to explore and understand interactions between factors influencing antibiotic prescribing for respiratory tract infections in primary care. Methods: Our mixed methods design was guided by the Triangulation Design Model according to Creswell. Quantitative and qualitative data were collected in parallel. Quantitative data were collected by prescription... (More)

Background: Prescribing of antibiotics for common infections varies widely, and there is no medical explanation. Systematic reviews have highlighted factors that may influence antibiotic prescribing and that this is a complex process. It is unclear how factors interact and how the primary care organization affects diagnostic procedures and antibiotic prescribing. Therefore, we sought to explore and understand interactions between factors influencing antibiotic prescribing for respiratory tract infections in primary care. Methods: Our mixed methods design was guided by the Triangulation Design Model according to Creswell. Quantitative and qualitative data were collected in parallel. Quantitative data were collected by prescription statistics, questionnaires to patients, and general practitioners' audit registrations. Qualitative data were collected through observations and semi-structured interviews. Results: From the analysis of the data from the different sources an overall theme emerged: A common practice in the primary health care centre is crucial for low antibiotic prescribing in line with guidelines. Several factors contribute to a common practice, such as promoting management and leadership, internalized guidelines including inter-professional discussions, the general practitioner's diagnostic process, nurse triage, and patient expectation. These factors were closely related and influenced each other. The results showed that knowledge must be internalized and guidelines need to be normative for the group as well as for every individual. Conclusions: Low prescribing is associated with adapted and transformed guidelines within all staff, not only general practitioners. Nurses' triage and self-care advice played an important role. Encouragement from the management level stimulated inter-professional discussions about antibiotic prescribing. Informal opinion moulders talking about antibiotic prescribing was supported by the managers. Finally, continuous professional development activities were encouraged for up-to-date knowledge.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Antibiotic prescribing, Guidelines, Implementation, Mixed methods design, Primary care
in
BMC Family Practice
volume
17
issue
1
publisher
BioMed Central
external identifiers
  • Scopus:84978472376
ISSN
1471-2296
DOI
10.1186/s12875-016-0494-z
language
English
LU publication?
yes
id
e96280b9-057b-4122-af1e-2e20f91d2cd9
date added to LUP
2016-08-02 09:58:14
date last changed
2016-09-20 03:06:10
@misc{e96280b9-057b-4122-af1e-2e20f91d2cd9,
  abstract     = {<p>Background: Prescribing of antibiotics for common infections varies widely, and there is no medical explanation. Systematic reviews have highlighted factors that may influence antibiotic prescribing and that this is a complex process. It is unclear how factors interact and how the primary care organization affects diagnostic procedures and antibiotic prescribing. Therefore, we sought to explore and understand interactions between factors influencing antibiotic prescribing for respiratory tract infections in primary care. Methods: Our mixed methods design was guided by the Triangulation Design Model according to Creswell. Quantitative and qualitative data were collected in parallel. Quantitative data were collected by prescription statistics, questionnaires to patients, and general practitioners' audit registrations. Qualitative data were collected through observations and semi-structured interviews. Results: From the analysis of the data from the different sources an overall theme emerged: A common practice in the primary health care centre is crucial for low antibiotic prescribing in line with guidelines. Several factors contribute to a common practice, such as promoting management and leadership, internalized guidelines including inter-professional discussions, the general practitioner's diagnostic process, nurse triage, and patient expectation. These factors were closely related and influenced each other. The results showed that knowledge must be internalized and guidelines need to be normative for the group as well as for every individual. Conclusions: Low prescribing is associated with adapted and transformed guidelines within all staff, not only general practitioners. Nurses' triage and self-care advice played an important role. Encouragement from the management level stimulated inter-professional discussions about antibiotic prescribing. Informal opinion moulders talking about antibiotic prescribing was supported by the managers. Finally, continuous professional development activities were encouraged for up-to-date knowledge.</p>},
  author       = {Strandberg, Eva Lena and Brorsson, Annika and André, Malin and Gröndal, Hedvig and Mölstad, Sigvard and Hedin, Katarina},
  issn         = {1471-2296},
  keyword      = {Antibiotic prescribing,Guidelines,Implementation,Mixed methods design,Primary care},
  language     = {eng},
  month        = {07},
  number       = {1},
  publisher    = {ARRAY(0x7d07cd0)},
  series       = {BMC Family Practice},
  title        = {Interacting factors associated with Low antibiotic prescribing for respiratory tract infections in primary health care - A mixed methods study in Sweden},
  url          = {http://dx.doi.org/10.1186/s12875-016-0494-z},
  volume       = {17},
  year         = {2016},
}