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BMC Fam Pract. 2014 Dec 12;15:194. doi: 10.1186/s12875-014-0194-5.

Primary care clinicians' perceptions about antibiotic prescribing for acute bronchitis: a qualitative study.

Author information

1
Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA. pdempsey1@partners.org.
2
Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA. abusinger@partners.org.
3
Bureau of Infectious Diseases, Massachusetts Department of Public Health, Boston, MA, USA. lewhaley@gmail.com.
4
Survey and Data Management Core, Dana Farber Cancer Institute, Boston, MA, USA. jjgagne@partners.org.
5
Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA. jlinder@partners.org.
6
Harvard Medical School, Boston, MA, USA. jlinder@partners.org.

Abstract

BACKGROUND:

Clinicians prescribe antibiotics to over 65% of adults with acute bronchitis despite guidelines stating that antibiotics are not indicated.

METHODS:

To identify and understand primary care clinician perceptions about antibiotic prescribing for acute bronchitis, we conducted semi-structured interviews with 13 primary care clinicians in Boston, Massachusetts and used thematic content analysis.

RESULTS:

All the participants agreed with guidelines that antibiotics are not indicated for acute bronchitis and felt that clinicians other than themselves were responsible for overprescribing. Barriers to guideline adherence included 6 themes: (1) perceived patient demand, which was the main barrier, although some clinicians perceived a recent decrease; (2) lack of accountability for antibiotic prescribing; (3) saving time and money; (4) other clinicians' misconceptions about acute bronchitis; (5) diagnostic uncertainty; and (6) clinician dissatisfaction in failing to meet patient expectations. Strategies to decrease inappropriate antibiotic prescribing included 5 themes: (1) patient educational materials; (2) quality reporting; (3) clinical decision support; (4) use of an over-the-counter prescription pad; and (5) pre-visit triage and education by nurses to prevent visits.

CONCLUSIONS:

Clinicians continued to cite patient demand as the main reason for antibiotic prescribing for acute bronchitis, though some clinicians perceived a recent decrease. Clinicians felt that other clinicians were responsible for inappropriate antibiotic prescribing and that better pre-visit triage by nurses could prevent visits and change patients' expectations.

PMID:
25495918
PMCID:
PMC4275949
DOI:
10.1186/s12875-014-0194-5
[Indexed for MEDLINE]
Free PMC Article

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