Family Practice Vol. 17, No. 5, 380-385
© Oxford University Press 2000
Antibiotics for coughing in general practice: a qualitative decision analysis
Centre for General Practice, University of Antwerp, Universiteitsplein 1, B-2610 Antwerp, Belgium.
Background. In family practice, medical decisions are prompted most often by complaints about coughing. There is no single yardstick for the differential diagnosis of respiratory tract infections (RTIs). In 80% of cases, the excessive use of antibiotics in the treatment of RTIs is caused by the prescription behaviour of GPs.
Objective. Our aim was to explicate GPs' diagnostic (and therapeutic) decisions regarding adult patients who consult them with complaints about coughing, and to investigate what determines decision making.
Methods. Exploratory, descriptive focus groups were held with GPs. Hypotheses were generated on the basis of ‘qualitative content analysis’.
Results. Twenty-four GPs participated in four semi-structured group discussions. In order to differentiate RTIs from other possible diagnoses, less likely diagnoses were not ruled out explicitly. In the case of suspected RTI, there was a low degree of certainty in the differentiation between RTIs (e.g. between bronchitis and pneumonia). Clinical signs and symptoms, which determine the probability of disease, often left GPs with reasonable diagnostic doubt. In the end, the decision whether or not to prescribe antibiotics was taken. GPs' prescription behaviour was also determined by doctor- and patient-related factors (e.g. having missed pneumonia once, patient expectations). The ‘chagrin factor’ explains why these factors lead to a shift in the action threshold, in favour of antibiotics.
Conclusion. This inductive research method enabled the generation of meaningful hypotheses regarding the complex decision processes pursued by GPs. The authors are developing an educational intervention that builds on these findings, focusing on the prescribing decision.
Keywords. Antibiotics, family practice, focus groups, medical decision making, respiratory tract infections.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  T. Fischer, S. Fischer, W. Himmel, M. M. Kochen, and E. Hummers-Pradier Family Practitioners' Diagnostic Decision-Making Processes Regarding Patients with Respiratory Tract Infections: An Observational Study Med Decis Making, November 1, 2008; 28(6): 810 - 818. [Abstract] [PDF]
|
|
|
|
 |
|
 L. Brooks, A. Shaw, D. Sharp, and A. D Hay Towards a better understanding of patients' perspectives of antibiotic resistance and MRSA: a qualitative study Fam. Pract., October 1, 2008; 25(5): 341 - 348. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Wood, S. Simpson, and C. C Butler Socially responsible antibiotic choices in primary care: a qualitative study of GPs' decisions to prescribe broad-spectrum and fluroquinolone antibiotics Fam. Pract., October 1, 2007; 24(5): 427 - 434. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M L van Driel, S Coenen, K Dirven, J Lobbestael, I Janssens, P Van Royen, F M Haaijer-Ruskamp, M De Meyere, J De Maeseneer, and T Christiaens What is the role of quality circles in strategies to optimise antibiotic prescribing? A pragmatic cluster-randomised controlled trial in primary care Qual. Saf. Health Care, June 1, 2007; 16(3): 197 - 202. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Aagaard, J. Maselli, and R. Gonzales Physician Practice Patterns: Chest X-Ray Ordering for the Evaluation of Acute Cough Illness in Adults Med Decis Making, November 1, 2006; 26(6): 599 - 605. [Abstract] [PDF]
|
|
|
|
|
|
R M Hopstaken, S Coenen, C C Butler, P Nelemans, J W M Muris, P E L M Rinkens, A D M Kester, and G J Dinant Prognostic factors and clinical outcome in acute lower respiratory tract infections: a prospective study in general practice Fam. Pract., October 1, 2006; 23(5): 512 - 519. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M Hopstaken, C. C Butler, J. W M Muris, J A. Knottnerus, A. D M Kester, P. E L M Rinkens, and G.-J. Dinant Do clinical findings in lower respiratory tract infection help general practitioners prescribe antibiotics appropriately? An observational cohort study in general practice Fam. Pract., April 1, 2006; 23(2): 180 - 187. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. M. Hopstaken, S. Coenen, and C. C. Butler Treating patients not diagnoses: challenging assumptions underlying the investigation and management of LRTI in general practice J. Antimicrob. Chemother., November 1, 2005; 56(5): 941 - 943. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Altiner, A. Knauf, J. Moebes, M. Sielk, and S. Wilm Acute cough: a qualitative analysis of how GPs manage the consultation when patients explicitly or implicitly expect antibiotic prescriptions Fam. Pract., October 1, 2004; 21(5): 500 - 506. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Coenen, P. Van Royen, B. Michiels, and J. Denekens Optimizing antibiotic prescribing for acute cough in general practice: a cluster-randomized controlled trial J. Antimicrob. Chemother., September 1, 2004; 54(3): 661 - 672. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. A Becker Verbal advice plus an information leaflet reduced antibiotic use in acute bronchitis Evid. Based Med., July 1, 2002; 7(4): 119 - 119. [Full Text] [PDF]
|
|
|
|
|
|
C Pope, P van Royen, and R Baker Qualitative methods in research on healthcare quality Qual. Saf. Health Care, June 1, 2002; 11(2): 148 - 152. [Abstract] [Full Text] [PDF]
|
|