Primary care clinician antibiotic prescribing decisions in consultations for children with RTIs
a qualitative interview study
Citation
Horwood, J, Cabral, C, Hay, AD & Ingram, J, 2016, ‘Primary care clinician antibiotic prescribing decisions in consultations for children with RTIs: a qualitative interview study’. British Journal of General Practice, vol 66., pp. e207-e213
Abstract
Background
Respiratory tract infections (RTIs) are a major primary care challenge
in children because they are common and costly, there is uncertainty
regarding their diagnosis, prognosis, and management, and the overuse of
antibiotics leads to illness medicalisation and bacterial resistance.
Aim To investigate healthcare professional (HCP) diagnostic and antibiotic prescribing decisions for children with RTIs.
Design and setting
Semi-structured interviews conducted with 22 GPs and six nurses. HCPs
were recruited from six general practices and one walk-in centre,
serving a mix of deprived and affluent areas.
Method Interviews were audiorecorded, transcribed, imported into NVivo 9, and analysed thematically.
Results
HCPs varied in the symptom and clinical examination findings used to
identify children they thought might benefit from antibiotics. Their
diagnostic reasoning and assessment of perceived clinical need for
antibiotics used a dual process, combining an initial rapid assessment
with subsequent detailed deductive reasoning. HCPs reported confidence
diagnosing and managing most minor and severe RTIs. However, residual
prognostic uncertainty, particularly for the intermediate illness
severity group, frequently led to antibiotic prescribing to mitigate the
perceived risk of subsequent illness deterioration. Some HCPs perceived
a need for more paediatrics training to aid treatment decisions. The
study also identified a number of non-clinical factors influencing
prescribing.
Conclusion
Prognostic uncertainty remains an important driver of HCPs’ antibiotic
prescribing. Experience and training in recognising severe RTIs,
together with more evidence to help HCPs identify the children at risk
of future illness deterioration, may support HCPs’ identification of the
children most and least likely to benefit from antibiotics.
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