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General practitioner and nurse prescriber experiences of prescribing antibiotics for respiratory tract infections in UK primary care out-of-hours services (the UNITE study)

Williams, S J, Halls, Amy, Tonkin-Crine, S, Moore, M V, Latter, S E, Little, P, Eyles, C, Postle, K and Leydon, G M (2017) General practitioner and nurse prescriber experiences of prescribing antibiotics for respiratory tract infections in UK primary care out-of-hours services (the UNITE study) Journal of Antimicrobial Chemotherapy, dkx429.

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Abstract

Background
Interventions are needed to reduce unnecessary antibiotic prescribing for respiratory tract infections (RTIs). Although community antibiotic prescribing appears to be decreasing in the UK, figures for out-of-hours (OOH) prescribing have substantially increased. Understanding the factors influencing prescribing in OOH and any perceived differences between general practitioner (GP) and nurse prescriber (NP) prescribing habits may enable the development of tailored interventions promoting optimal prescribing in this setting.

Objectives
To explore UK GP and NP views on and experiences of prescribing antibiotics for RTIs in primary care OOH services.

Methods
Thirty semi-structured interviews were conducted with GPs and NPs working in primary care OOH services. Inductive thematic analysis was used to analyse data.

Results
The research shows that factors particular to OOH influence antibiotic prescribing, including a lack of patient follow-up, access to patient GP records, consultation time, working contracts and implementation of feedback, audit and supervision. NPs reported perceptions of greater accountability for their prescribing compared with GPs and reported they had longer consultations during which they were able to discuss decisions with patients. Participants agreed that more complex cases should be seen by GPs and highlighted the importance of consistency of decision making, illness explanations to patients as well as a perception that differences in clinical training influence communication with patients and antibiotic prescribing decisions.

Conclusions
Environmental and social factors in OOH services and a mixed healthcare workforce provide unique influences on antibiotic prescribing for RTIs, which would need to be considered in tailoring interventions that promote prudent antibiotic prescribing in OOH services.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Health Sciences
Authors :
NameEmailORCID
Williams, S JUNSPECIFIEDUNSPECIFIED
Halls, Amya.v.halls@surrey.ac.ukUNSPECIFIED
Tonkin-Crine, SUNSPECIFIEDUNSPECIFIED
Moore, M VUNSPECIFIEDUNSPECIFIED
Latter, S EUNSPECIFIEDUNSPECIFIED
Little, PUNSPECIFIEDUNSPECIFIED
Eyles, CUNSPECIFIEDUNSPECIFIED
Postle, KUNSPECIFIEDUNSPECIFIED
Leydon, G MUNSPECIFIEDUNSPECIFIED
Date : 27 November 2017
Identification Number : 10.1093/jac/dkx429
Uncontrolled Keywords : Antibiotics; Nurses; Physicians; Family; Primary health care; Respiratory tract infections; Prescribing behavior
Related URLs :
Depositing User : Clive Harris
Date Deposited : 18 Dec 2017 14:29
Last Modified : 18 Dec 2017 14:31
URI: http://epubs.surrey.ac.uk/id/eprint/845436

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