How do general practitioners make antibiotic prescribing decisions for patients with upper respiratory tract infection?

Abstract

Background: Over-prescribing of antibiotics is widespread and poses significant public health problems. Previous studies have identified generic factors involved in prescribing decision-making. This study used the Think-Aloud’ method, where participants verbalise their thoughts while making decisions, to investigate how General Practitioners (GPs) make prescribing decisions. Methods: In individual interviews, five GPs responded to seven patient scenarios by thinking aloud while making prescribing decisions. Scenarios were constructed to include features representative of real patients. Interview transcripts were coded for the information used in the decision process. An inductive approach identified further emergent themes. Findings: Patient information used in the decision process included perceived illness severity, illness duration, and patient preferences. Duration was a key influence: when perceived as extended, decisions and associated justifications varied. Emergent themes included variation across GPs in a) interpretation of clinical features and corresponding guideline recommendations, and b) emphasis on the importance of shared decision-making. Discussion: Over-prescribing of antibiotics may be linked to differing interpretations of patient information. Interventions aimed at improving prescribing may be more effective when tailored to take these differences into account.