Background Antibiotics are being overprescribed in ambulant care, especially for respiratory

Background Antibiotics are being overprescribed in ambulant care, especially for respiratory tract infections (RTIs). 42.8 years; 65.9% men) approximated that of all Flemish GPs. Participants considered all the items 88110-89-8 IC50 included in the questionnaire: always the operational factor ‘lung auscultation’, often ‘whether or not there is something unusual happening’ C both medical reasons C and to a lesser extent ‘nonmedical reasons’ (P < 0.001). Non-medical as well as medical reasons support antibiotic treatment, but non-medical reasons to a lesser extent (P < 0.001). Conclusion This study quantified, condensed and confirmed the findings of previous focus group research. Practice guidelines and interventions to optimise antibiotic prescribing have to take non-medical reasons into account. Background Antibiotics are being overprescribed in ambulant care,[1] especially for respiratory tract infections (RTIs).[2] For this prescribing decision different types of determinants are FAS already highlighted. [3-6] However, gaining insight into the actual reasons for context specific prescribing remains important to design effective strategies to optimise antibiotic prescribing.[7] In general practice, medical decisions (concerning RTIs) are prompted most often by complaints about coughing: 169 times per 1000 patients per year for a new illness episode.[8] Since there is no evidence base for the prescription of antibiotics for coughing in case of suspected RTI,[9] and since 88110-89-8 IC50 antibiotic prescribing results in financial costs to the patient and society, adverse effects and development of bacterial 88110-89-8 IC50 resistance,[10] we explored the diagnostic and therapeutic decisions of Flemish general practitioners (GPs) regarding adult patients who consult them with complaints about coughing by means of focus groups.[11] We found medical as well as nonmedical reasons for antibiotic prescriptions in case of suspected RTI.[12] Our hypotheses on Flemish GPs’ decisions were in line with previous research. The differentiation between RTIs, e.g. acute bronchitis and pneumonia, could 88110-89-8 IC50 not be achieved with certainty on the basis of medical history and clinical examination:[13] i.e. medical reasons. Dealing with this diagnostic uncertainty, GPs’ decisions were directed at whether or not to prescribe antibiotics.[14] Determinants playing an important role in this decision are physician related, e.g. having missed pneumonia once, or patient related, e.g. patient expectations:[15] i.e. non-medical reasons. Since it is time for action,[16] besides a better understanding of the actual determinants for context specific prescribing of antibiotics, we also have to make them operational for the design of an intervention. Therefore, we aimed to quantify and to condense the determinants generated in the focus group study. By means of this postal questionnaire study in Flemish general practice, we assessed to what extent Flemish GPs consider those determinants in decision making in case of suspected RTI in a coughing patient and how strongly the determinants support or counter antibiotic treatment. Methods Design We performed an explanatory study comparing GPs’ responses from a self-administered questionnaire based upon focus group findings.12 Setting and sample We approached Flemish GPs who were willing to participate in previous studies of our research unit [12,17]. The questionnaire was sent to this selected group by mail early September 1999. A reminder was sent to all nonresponders two weeks later. Responses were accepted until the end of September 1999. The survey was pilot tested. Of the 316 GPs originally selected to be in the sample, 7 were 88110-89-8 IC50 no longer practising, 5 returned surveys with more than 20% of items unanswered, 116 failed to respond before the end of September 1999, leaving 188 GPs who completed the survey. The overall response rate was 59.5%. Instrument To assess the importance of determinants for the antibiotic prescribing decision the GPs were sent one questionnaire in two parts, one (Q1) assessing to what extent they consider these determinants in decision making in case of suspected RTI in a coughing patient, and another (Q2) assessing.

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