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

Area of Science:

• Primary Care Research
• Infectious Disease Management
• Health Services Research

Background:

• Antibiotic resistance is a growing global health threat.
• Inappropriate antibiotic prescribing for respiratory tract infections (RTIs) contributes to resistance.
• Optimizing antibiotic use in primary care is essential for antimicrobial stewardship.

Purpose of the Study:

• To explore factors and circumstances influencing prudent antibiotic prescribing for RTIs in primary care.
• To identify key elements that support rational antibiotic decision-making in general practice.

Main Methods:

• Qualitative study utilizing two focus groups (rural and urban) with general practitioners (GPs).
• Semi-structured interviews with open-ended questions, analyzed using an editing analysis style.
• Iterative process of identifying meaning units, sorting into categories, and theme determination.

Main Results:

• The GP-patient encounter dynamics (harmony, fight, collaboration, negotiation) significantly impact antibiotic prescribing decisions.
• Factors influencing rational prescribing include GP characteristics, the therapeutic relationship, and the practice setting (organization and professional culture).
• Continuity of care and mutual trust are vital for successful consultations, even with limited time, while their absence can negate professional expertise.

Conclusions:

• The GP-patient encounter is pivotal for achieving prudent antibiotic prescribing in primary care.
• Effective primary care organization, fostering continuity and professional autonomy, is crucial for enhancing rational antibiotic use.