Exploring general practitioners’ perception of the value of natural history information and their awareness and use of guidelines’ resources to support antibiotic prescribing for self-limiting infections: a qualitative study in Australian general practice
Kwame Peprah Boaitey
A * , Tammy Hoffmann A , Emma Baillie A and Mina Bakhit A
A Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Drive, Robina, Qld 4229, Australia.
Abstract
The newest version of the Therapeutic Guidelines’ antibiotic chapter introduced patient- and clinician-facing resources to support decision-making about antibiotic use for self-limiting infections. It is unclear whether general practitioners (GPs) are aware of and use these resources, including the natural history information they contain. We explored GPs’ perceptions of the value and their use of natural history information, and their use of the Therapeutic Guidelines’ resources (summary table, discussion boxes, decision aids) to support antibiotic decision-making.
Semi-structured interviews with 21 Australian GPs were conducted. Interviews were recorded, transcribed and thematically analysed by two independent researchers.
Four themes emerged: (1) GPs perceive natural history information as valuable in consultations for self-limiting conditions and use it for a range of purposes, but desire specific information for infectious and non-infectious conditions; (2) GPs’ reasons for using patient-facing resources were manifold, including managing patients’ expectations for antibiotics, legitimising the decision not to provide antibiotics and as a prescription substitute; (3) the guidelines are a useful and important educational resource, but typically not consulted at the time of deciding whether to prescribe antibiotics; and (4) experience and attitude towards shared decision-making and looking up information during consultations influenced whether GPs involved patients in decision-making and used a decision aid.
GPs perceived natural history information to be valuable in discussions about antibiotic use for self-limiting conditions. Patient and clinician resources were generally perceived as useful, although reasons for use varied, and a few barriers to use were reported.
Keywords: antibiotic prescribing, clinical practice guidelines, decision support techniques, general practice, natural history, primary care, qualitative study, self-limiting acute infections.
References
Biezen R, Grando D, Mazza D, Brijnath B (2019a) Dissonant views – GPs’ and parents’ perspectives on antibiotic prescribing for young children with respiratory tract infections. BMC Family Practice 20, 46.
| Crossref | Google Scholar |
Biezen R, Roberts C, Buising K, Thursky K, Boyle D, Lau P, Clark M, Manski-Nankervis J-A (2019b) How do general practitioners access guidelines and utilise electronic medical records to make clinical decisions on antibiotic use? Results from an Australian qualitative study. BMJ Open 9, e028329.
| Crossref | Google Scholar |
Boaitey KP, Bakhit M, Krzyzaniak N, Hoffmann TC (2022) Information about the natural history of acute infections commonly seen in primary care: a systematic review of clinical practice guidelines. BMC Infectious Diseases 22, 897.
| Crossref | Google Scholar |
Braun V, Clarke V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77-101.
| Crossref | Google Scholar |
Coxeter P, Del Mar CB, Mcgregor L, Beller EM, Hoffmann TC (2015) Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care. The Cochrane Database of Systematic Reviews 2015, CD010907.
| Crossref | Google Scholar |
Coxeter PD, Mar CD, Hoffmann TC (2017) Parents’ expectations and experiences of antibiotics for acute respiratory infections in primary care. The Annals of Family Medicine 15, 149-154.
| Crossref | Google Scholar |
Dobler CC, Sanchez M, Gionfriddo MR, Alvarez-Villalobos NA, Singh Ospina N, Spencer-Bonilla G, Thorsteinsdottir B, Benkhadra R, Erwin PJ, West CP, Brito JP, Murad MH, Montori VM (2019) Impact of decision aids used during clinical encounters on clinician outcomes and consultation length: a systematic review. BMJ Quality & Safety 28, 499-510.
| Crossref | Google Scholar |
Driel MLv, Sutter AD, Deveugele M, Peersman W, Butler CC, Meyere MD, Maeseneer JD, Christiaens T (2006) Are sore throat patients who hope for antibiotics actually asking for pain relief? The Annals of Family Medicine 4, 494-499.
| Crossref | Google Scholar |
Eley CV, Lecky DM, Hayes CV, Mcnulty CAM (2020) Is sharing the TARGET respiratory tract infection leaflet feasible in routine general practice to improve patient education and appropriate antibiotic use? A mixed methods study in England with patients and healthcare professionals. Journal of Infection Prevention 21, 97-107.
| Crossref | Google Scholar |
Hoffmann TC, Légaré F, Simmons MB, McNamara KP, McCaffery K, Trevena LJ, Hudson B, Glasziou PP, Del Mar CB (2014) Shared decision making: what do clinicians need to know and why should they bother? Medical Journal of Australia 201 35-39.
| Crossref | Google Scholar |
Hoffmann T, Beckhaus J, Del Mar C (2021) ‘What happens if I do nothing?’ A systematic review of the inclusion and quantitative description of a ‘no active intervention’ option in patient decision aids. Journal of General Internal Medicine 36, 3897-3899.
| Crossref | Google Scholar |
Hoffmann TC, Jones M, Glasziou P, Beller E, Trevena L, Mar CD (2022) A brief shared decision-making intervention for acute respiratory infections on antibiotic dispensing rates in primary care: a cluster randomized trial. The Annals of Family Medicine 20, 35-41.
| Crossref | Google Scholar |
Llor C, Bjerrum L (2014) Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Therapeutic Advances in Drug Safety 5, 229-241.
| Crossref | Google Scholar |
McCullough AR, Pollack AJ, Plejdrup Hansen M, Glasziou PP, Looke DFM, Britt HC, Del Mar CB (2017) Antibiotics for acute respiratory infections in general practice: comparison of prescribing rates with guideline recommendations. Medical Journal of Australia 207, 65-69.
| Crossref | Google Scholar |
Ryves R, Eyles C, Moore M, McDermott L, Little P, Leydon GM (2016) Understanding the delayed prescribing of antibiotics for respiratory tract infection in primary care: a qualitative analysis. BMJ Open 6, e011882.
| Crossref | Google Scholar |
Spinks A, Glasziou PP, Del Mar CB (2021) Antibiotics for treatment of sore throat in children and adults. Cochrane Database of Systematic Reviews 2021(12), CD000023.
| Crossref | Google Scholar |
Spurling GKP, Del Mar CB, Dooley L, Clark J, Askew DA (2017) Delayed antibiotic prescriptions for respiratory infections. Cochrane Database of Systematic Reviews 2017(9), CD004417.
| Crossref | Google Scholar |
Stacey D, Légaré F, Lewis K, Barry MJ, Bennett CL, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Thomson R, et al. (2017) Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews 2017(4), CD001431.
| Crossref | Google Scholar |
Stivers T, Mangione-Smith R, Elliott MN, Mcdonald L, Heritage J (2003) Why do physicians think parents expect antibiotics? What parents report vs what physicians believe. The Journal of Family Practice 52, 140-148.
| Google Scholar |
Therapeutic Guidelines (2019) Summary table for the antibiotic management of common conditions in primary care available now. Theraputic Guideline Limited, North Melbourne, Vic. Available at https://www.tg.org.au/news/antibiotic-summary-table/ [Accessed 22 May 2023]
Therapeutic Guidelines (2023) eTG complete [Therapeutic Guidelines] [Online]. Therapeutic Guidelines Limited, North Melbourne, Vic. Available at https://www.tg.org.au/ [Accessed 22 May 2023]
Wilcock M, Hughes P, Gibson N (2015) Do GPs think patient decision aids are a useful tool? Prescriber 26, 11-14.
| Crossref | Google Scholar |
World Health Organization (2015) Global action plan on antimicrobial resistance. Available at https://www.who.int/publications/i/item/9789241509763 [Accessed 22 May 2023]
