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Antibiotics for coughing in general practice: a qualitative decision analysis
S Coenen1, P Van Royen, E Vermeire
1Centre for General Practice, University of Antwerp, Universiteitsplein 1, B-2610 Antwerp, Belgium.
Family Practice
|October 6, 2000
Summary
General practitioners (GPs) often face diagnostic uncertainty with cough complaints, leading to excessive antibiotic prescribing for respiratory tract infections (RTIs). Decision-making is influenced by various factors beyond clinical signs.
Area of Science:
- Family Medicine
- General Practice
- Infectious Diseases
Background:
- Cough is a frequent primary care complaint, often leading to respiratory tract infections (RTIs).
- Current diagnostic approaches lack a definitive method for differentiating RTIs.
- General practitioners (GPs) contribute to 80% of excessive antibiotic use for RTIs due to prescribing behaviors.
Purpose of the Study:
- To understand GPs' diagnostic and therapeutic decision-making for adult patients presenting with cough.
- To identify factors influencing GPs' decisions in diagnosing and treating cough-related illnesses.
Main Methods:
- Exploratory, descriptive focus groups were conducted with 24 GPs.
- Qualitative content analysis was used to generate hypotheses.
- Semi-structured group discussions explored diagnostic and therapeutic choices.
Main Results:
- GPs exhibited low certainty in differentiating between various RTIs (e.g., bronchitis vs. pneumonia).
- Clinical signs alone often resulted in diagnostic doubt, influencing antibiotic prescription decisions.
- Doctor- and patient-related factors, including the 'chagrin factor,' shifted the threshold towards antibiotic prescribing.
Conclusions:
- The study generated hypotheses on complex GP decision-making processes in cough cases.
- Findings highlight the need for interventions to refine prescribing decisions for RTIs.
- An educational intervention focusing on prescribing decisions is under development.