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dc.contributor.authorBrookes-Howell, Lucy
dc.contributor.authorHood, Kerenza
dc.contributor.authorCooper, Lucy
dc.contributor.authorCoenen, Samuel
dc.contributor.authorLittle, Paul
dc.contributor.authorVerheij, Theo
dc.contributor.authorGodycki-Cwirko, Maciek
dc.contributor.authorMelbye, Hasse
dc.contributor.authorKrawzyk, Jarek
dc.contributor.authorBorras-Santos, A
dc.contributor.authorJakobsen, Kristin Alise
dc.contributor.authorWorby, P
dc.contributor.authorGoossens, Herman
dc.contributor.authorButler, Christopher C.
dc.date.accessioned2013-03-13T15:04:15Z
dc.date.available2013-03-13T15:04:15Z
dc.date.issued2012
dc.description.abstractThere is variation in antibiotic prescribing for lower respiratory tract infections (LRTI) in primary care that does not benefit patients. This study aims to investigate clinicians' accounts of clinical influences on antibiotic prescribing decisions for LRTI to better understand variation and identify opportunities for improvement. Multi country qualitative interview study. Semi-structured interviews using open-ended questions and a patient scenario. Data were subjected to five-stage analytic framework approach (familiarisation, developing a thematic framework from the interview questions and emerging themes, indexing, charting and mapping to search for interpretations), with interviewers commenting on preliminary reports. 80 primary care clinicians randomly selected from primary care research networks based in nine European cities. Clinicians reported four main individual clinical factors that guided their antibiotic prescribing decision: auscultation, fever, discoloured sputum and breathlessness. These were considered alongside a general impression of the patient derived from building a picture of the illness course, using intuition and familiarity with the patient. Comorbidity and older age were considered main risk factors for poor outcomes. Clinical factors were similar across networks, apart from C reactive protein near patient testing in Tromsø. Clinicians developed ways to handle diagnostic and management uncertainty through their own clinical routines. Clinicians emphasised the importance of auscultation, fever, discoloured sputum and breathlessness, general impression of the illness course, familiarity with the patient, comorbidity, and age in informing their antibiotic prescribing decisions for LRTI. As some of these factors may be overemphasised given the evolving evidence base, greater standardisation of assessment and integration of findings may help reduce unhelpful variation in management. Non-clinical influences will also need to be addressed.en
dc.identifier.citationBMJ Open (2012), vol.2:e000795en
dc.identifier.cristinIDFRIDAID 999057
dc.identifier.doihttp://dx.doi.org/10.1136/bmjopen-2011-000795
dc.identifier.issn2044-6055
dc.identifier.urihttps://hdl.handle.net/10037/5014
dc.identifier.urnURN:NBN:no-uit_munin_4697
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.titleClinical influences on antibiotic prescribing decisions for lower respiratory tract infection: a nine country qualitative study of variation in care.en
dc.typeJournal articleen
dc.typeTidsskriftartikkelen
dc.typePeer revieweden


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