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dc.contributor.authorBrookes-Howell, Lucy
dc.contributor.authorHood, Kerenza
dc.contributor.authorCooper, Lucy
dc.contributor.authorLittle, Paul
dc.contributor.authorVerheij, Theo
dc.contributor.authorCoenen, Samuel
dc.contributor.authorGodycki-Cwirko, Maciek
dc.contributor.authorMelbye, Hasse
dc.contributor.authorBorras-Santos, A
dc.contributor.authorWorby, P
dc.contributor.authorJakobsen, Kristin Alise
dc.contributor.authorGoossens, Herman
dc.contributor.authorButler, Christopher C.
dc.date.accessioned2013-03-13T14:59:22Z
dc.date.available2013-03-13T14:59:22Z
dc.date.issued2012
dc.description.abstractThere is a wide variation between European countries in antibiotic prescribing for patients in primary care with lower respiratory tract infection (LRTI) that is not explained by case mix and clinical factors alone. Variation in antibiotic prescribing that is not warranted by differences in illness and clinical presentation may increase selection of resistant organisms, contributing to the problem of antibiotic resistance. This study aimed to investigate clinicians’ accounts of non-clinical factors that influence their antibiotic prescribing decision for patients with LRTI, to understand variation and identify opportunities for addressing possible unhelpful variation. Qualitative semistructured interview study, with data subjected to a five-stage analytic framework approach (familiarisation, developing a thematic framework from interview questions and emerging themes, indexing, charting and interpretation), and with interviewers commenting on preliminary analytic themes. Eighty primary care clinicians randomly selected from primary care research networks based in nine European cities. Clinicians’ accounts identified non-clinical factors imposed by the healthcare system operating within specific regional primary care research networks, including patient access to antibiotics before consulting a doctor (Barcelona and Milan), systems to reduce patient expectations for antibiotics (Southampton and Antwerp) and lack of consistent treatment guidelines (Balatonfüred and Łódź). Secondly, accounts revealed factors related to specific characteristics of clinicians regardless of network (professional ethos, self-belief in decision-making and commitment to shared decision-making). Addressing healthcare system factors (eg, limiting patients’ self-management with antibiotics before consulting in primary care, increased public awareness and provision of more consistent guidelines) may assist in reducing unhelpful variation in antibiotic prescribing. Promoting clinicians’ receptivity to change, confidence in decision-making and readiness to invest in explaining prescribing decisions may also be beneficial. As factors were emphasised differently between networks, local flexibility in interventions is likely to maximise effectiveness.en
dc.identifier.citationBMJ Open (2012); vol.2:e000796en
dc.identifier.cristinIDFRIDAID 999040
dc.identifier.doihttp://dx.doi.org/10.1136/bmjopen-2011-000796
dc.identifier.issn2044-6055
dc.identifier.urihttps://hdl.handle.net/10037/5013
dc.identifier.urnURN:NBN:no-uit_munin_4692
dc.language.isoengen
dc.rights.accessRightsopenAccess
dc.subjectVDP::Medical disciplines: 700::Health sciences: 800::Community medicine, Social medicine: 801en
dc.subjectVDP::Medisinske Fag: 700::Helsefag: 800::Samfunnsmedisin, sosialmedisin: 801en
dc.titleUnderstanding variation in primary medical care: a nine-country qualitative study of clinicians' accounts of the non-clinical factors that shape antibiotic prescribing decisions for lower respiratory tract infection.en
dc.typeJournal articleen
dc.typeTidsskriftartikkelen
dc.typePeer revieweden


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