Acute cough: A qualitative analysis of how GPs manage the consultation when patients explicitly or implicitly expect antibiotic prescriptions

General Practice, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, North Rhine-Westphalia, Germany
Family Practice (Impact Factor: 1.86). 11/2004; 21(5):500-6. DOI: 10.1093/fampra/cmh505
Source: PubMed


The aim of this study was to analyse how GPs manage the consultation for acute cough when patients explicitly or implicitly expect antibiotic prescriptions.
A qualitative analysis of audio-taped consultations was carried out. The participants were eight GPs from eight general practices in Northrhine, Germany and their 42 patients with acute cough over a 2 week period. Three researchers analysed the consultations independently, finally agreed by discussion.
Implicit expectations for antibiotics were found frequently, but in none of the 42 consultations was the patient asked directly what she or he expected in terms of therapy. The topic of expectations and demands itself normally was not discussed at all, not even in a non-direct manner. In some consultations, the possibility of an antibiotic prescription was ruled out by the GP from the beginning. In some consultations, even a 'pseudo-consent' was found, avoiding any explicit clarification.
GPs seem to overestimate the actual pressure to prescribe antibiotics for acute cough. The (over) prescription of antibiotics might not be a question of knowledge but a lack of patient centredness.

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    • "Altiner et al. report as a result of a qualitative study that physicians often tend to misinterpret the patients’ demands and often feel urged by the patients to give them an antibiotic prescription. This pressure is especially felt in consultations with Turkish immigrants [35,36]. "
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    ABSTRACT: Background Medicines to treat common colds (CC) and upper respiratory tract infections (URTI) are widely used among children, but there are only few data about treatments actually applied for these diseases. In the present study we analyze the prevalence and correlations of self-medicated and prescribed drug use for the treatment of CCs and URTIs among children and adolescents in Germany. Methods Medicine use during the week preceding the interview was recorded among 17,450 children (0–17 years) who participated in the drug interview of the 2003–2006 German Health Interview and Examination Survey for Children and Adolescents (KiGGS). The definition of CCs and URTIs in the present study included the WHO-ICD-10 codes J00, J01.0, J01.9, J02.0, J02.9, J03.0, J03.9, J04.0, J06.8, J06.9, J11.1, J11.8, R05 and R07.0. Using the complex sample method, the prevalence and associated socio-demographic factors of self-medication, prescribed medicines and antibiotics were defined. Results 13.8% of the participating girls and boys use drugs to treat a CC or an URTI. About 50% of this group use prescribed medications. Among the users of prescribed medication, 11.5% use antibiotics for the treatment of these diseases. Looking at all prescribed medicines we find associations with younger age, immigration background, and lower social status. Antibiotic use in particular is associated with female sex, higher age, residency in the former East Germany and immigration background. Conclusions The use of medicines to treat CCs or URTIs is widespread among children and adolescents in Germany. Thus, longitudinal studies should investigate the risks associated with this drug use. Differences in socio-demographic variables regarding exposure to antibiotic use indicate that there could be an implausible prescribing behavior among physicians in Germany.
    Full-text · Article · Aug 2014 · BMC pharmacology & toxicology
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    • "Physician decision-making about antibiotics typically occurs within consultations between individual physicians and patients, and non-pharmacological factors can be pivotal in determining whether or not antibiotics are prescribed. Factors identified in the literature include physicians' uncertainty about optimal diagnosis and treatment (10,11); fear of legal action if the patient's health deteriorates (12); the patients' expectation that antibiotics will be prescribed (13); physicians' use of communication skills to identify and address patient expectations (14); patients' misconceptions regarding the efficacy of antibiotics (15,16); and physicians' ability and willingness to address those misconceptions (17). The complex interaction that shapes physician decision-making about antibiotics is also informed by a particular cultural context (18). "
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    ABSTRACT: Introduction General practitioners (GPs) write about 80% of all antibiotic prescriptions, the greatest number of them for patients with respiratory tract infections. However, there is a lack of research targeting the influence of external factors on antibiotic prescribing by physicians. This study aimed to explore experiences of GPs in Lithuania and the Russian Federation with regard to antibiotic prescription for upper respiratory tract infections. By such means it might be possible to reveal external enabling factors that influence antibiotic prescribing in these countries. Method Five focus groups were performed with 22 GPs from Lithuania and 29 GPs from the Kaliningrad Region of the Russian Federation; then, thematic analysis of data was performed. Results Six thematic categories were identified that are related to external forces enabling antibiotic prescription: the necessity for political leadership to encourage clinically grounded antibiotic use; over-the-counter sale of antibiotics; designation of antibiotics as reimbursable medications; supervision by external oversight institutions; lack of guidelines for the treatment of upper respiratory tract infections; and pharmaceutical company activities. Conclusions Comprehensive efforts to reduce the burden of non-clinically grounded antibiotic prescription should go beyond addressing factors at the physician–patient level and take into account important factors in the enabling environment as well.
    Full-text · Article · Mar 2013 · Upsala journal of medical sciences
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    • "Other studies confirm that not only Lithuanian and Russian patients are very confident about the efficacy and safety of antibiotics [41], though there are data that GPs could overestimate patients' expectations for antibiotics. A German study based on audio-recorded consultations of GPs for acute cough [14] found that normally patients' expectations for antibiotics are not addressed directly or indirectly. As a result, GPs can have an erroneous understanding of patient expectations. "
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    ABSTRACT: Background. Globally, general practitioners (GPs) write more than 90% of all antibiotic prescriptions. This study examines the experiences of Lithuanian and Russian GPs in antibiotic prescription for upper respiratory tract infections, including their perceptions of when it is not indicated clinically or pharmacologically. Methods. 22 Lithuanian and 29 Russian GPs participated in five focus group discussions. Thematic analysis was used to analyse the data. Results. We identified four main thematic categories: patients’ faith in antibiotics as medication for upper respiratory tract infections; patient potential to influence a GP’s decision to prescribe antibiotics for upper respiratory tract infections; impediments perceived by GPs in advocating clinically grounded antibiotic prescribing with their patients, and strategies applied in physician-patient negotiation about antibiotic prescribing for upper respiratory tract infections. Conclusions. Understanding the nature of physician-patient interaction is critical to the effective pursuit of clinically grounded antibiotic use as this study undertaken in Lithuania and the Russian Federation has shown. Both physicians and patients must be targeted to ensure correct antibiotic use. Further, GPs should be supported in enhancing their communication skills about antibiotic use with their patients and encouraged to implement a shared decision-making model in their practices.
    Full-text · Article · Dec 2012 · Central European Journal of Medicine
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