Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE (Open Access)

Perceptions of barriers to the management of respiratory tract infections in general practice settings in Australia

Stephanie Fletcher-Lartey A C and Rabia Khan B
+ Author Affiliations
- Author Affiliations

A Public Health Unit, South Western Sydney Local Health District, PO Box 38, Liverpool, NSW 1871, Australia.

B Organisation for Economic Co-operation and Development, 2, rue André Pascal, Cedex 16, F-75775 Paris, France.

C Corresponding author. Email: stephanie.fletcher@sswahs.nsw.gov.au

Australian Journal of Primary Health - https://doi.org/10.1071/PY17017
Submitted: 15 February 2017  Accepted: 9 July 2017   Published online: 21 September 2017

Journal Compilation © La Trobe University 2017 Open Access CC BY-NC-ND

Abstract

Inappropriate prescribing of antibiotics for the management of respiratory tract infections (RTIs) has contributed to increased prevalence of antibiotic resistance, and this remains a challenge. The aim of this study was to evaluate the effect of general practitioners’ (GPs) participation in the Antibiotics: Clinical e-Audit, a quality-improvement activity, on GP self-reported knowledge and practice change, and explored barriers encountered in the management of respiratory tract infections (RTIs). Participants completed a survey at the end of the activity to assess the usefulness of the audit, any reported changes made and barriers encountered to their clinical practice. More than half of the 872 participants reported the audit assisted them in reviewing patients with RTIs. The majority of GP registrars (48.2%, N = 66) indicated that the clinical e-Audit had changed their practice in terms of identifying patients for whom an antibiotic was recommended. GPs identified several barriers to achieving best practice in the management of RTIs, including patient or carer expectations for an antibiotic prescription and non-adherence to symptomatic management by patients. Empowering GPs to overcome these barriers should be the aim of future education and behaviour change programs.

Additional keywords: antibiotic prescribing, antimicrobial stewardship, Clinical e-Audit, quality improvement activity, symptomatic management.


References

Antibiotic Expert Group (2010) Therapeutic Guidelines: Antibiotic. Version 14. Therapeutic Guidelines Limited, Melbourne, Vic., Australia.

Coxeter P, Del Mar CB, McGregor L, Beller EM, Hoffmann TC (2015) Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care. Cochrane Database of Systematic Reviews 2015, CD010907
Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care.CrossRef |

Daley D (2012) Staphylococcus aureus programme 2012 (SAP 2012), community survey antimicrobial susceptibility report. PhD dissertation, University of Adelaide, Adelaide, SA, Australia.

Del Mar C, Glasziou P, Lowe JB, Van Driel ML, Hoffmann T, Beller E (2012) Addressing antibiotic resistance: focusing on acute respiratory infections in primary care. Australian Family Physician 41, 839–840.

Doust J, Del Mar C (2004) Why do doctors use treatments that do not work? For many reasons – including their inability to stand idle and do nothing. British Medical Journal 328, 474–475.
Why do doctors use treatments that do not work? For many reasons – including their inability to stand idle and do nothing.CrossRef |

Earnshaw S, Mendez A, Monnet DL, Hicks L, Cruickshank M, Weekes L, Njoo H, Ross S (2013) Global collaboration to encourage prudent antibiotic use. The Lancet Infectious Diseases 13, 1003–1004.
Global collaboration to encourage prudent antibiotic use.CrossRef |

Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P, Cording E, Tomson D, Dodd C, Rollnick S, Edwards A (2012) Shared decision making: a model for clinical practice. Journal of General Internal Medicine 27, 1361–1367.
Shared decision making: a model for clinical practice.CrossRef |

Essack S, Pignatari AC (2013) A framework for the non-antibiotic management of upper respiratory tract infections: towards a global change in antibiotic resistance. International Journal of Clinical Practice 67, 4–9.
A framework for the non-antibiotic management of upper respiratory tract infections: towards a global change in antibiotic resistance.CrossRef |

Fletcher-Lartey S, Yee M, Gaarslev C, Khan R (2016) Why do general practitioners prescribe antibiotics for upper respiratory tract infections to meet patient expectations: a mixed methods study. BMJ Open 6, e012244
Why do general practitioners prescribe antibiotics for upper respiratory tract infections to meet patient expectations: a mixed methods study.CrossRef |

Gaarslev C, Yee M, Chan G, Fletcher-Lartey S, Khan R (2016) A mixed methods study to understand patient expectations for antibiotics for an upper respiratory tract infection. Antimicrobial Resistance and Infection Control 5, 39–48.
A mixed methods study to understand patient expectations for antibiotics for an upper respiratory tract infection.CrossRef |

Huston SA, Porter KB, Clements T, Shepherd G (2010) Pharmacists’ attitudes towards pediatric cough and cold products and behind the counter status. The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG 15, 126–137.

Lewis PJ, Tully MP (2011) The discomfort caused by patient pressure on the prescribing decisions of hospital prescribers. Research in Social & Administrative Pharmacy 7, 4–15.
The discomfort caused by patient pressure on the prescribing decisions of hospital prescribers.CrossRef |

Little P, Dorward M, Warner G, Stephens K, Senior J, Moore M (2004) Importance of patient pressure and perceived pressure and perceived medical need for investigations, referral, and prescribing in primary care: nested observational study. British Medical Journal 328, 444–446.
Importance of patient pressure and perceived pressure and perceived medical need for investigations, referral, and prescribing in primary care: nested observational study.CrossRef |

McNulty CAM, Nichols T, French DP, Joshi P, Butler CC (2013) Expectations for consultations and antibiotics for respiratory tract infection in primary care: the RTI clinical iceberg. The British Journal of General Practice 63, 429–436.
Expectations for consultations and antibiotics for respiratory tract infection in primary care: the RTI clinical iceberg.CrossRef |

Meeker D, Linder JA, Fox CR, Friedberg MW, Persell SD, Goldstein NJ, Knight TK, Hay JW, Doctor JN (2016) Effect of behavioral interventions on inappropriate antibiotic prescribing among primary care practices: a randomized clinical trial. Journal of the American Medical Association 315, 562–570.
Effect of behavioral interventions on inappropriate antibiotic prescribing among primary care practices: a randomized clinical trial.CrossRef | 1:CAS:528:DC%2BC28XhtFKqtrjJ&md5=73218789f62290a682ac8f29833e4396CAS |

National Health and Medical Research Council (2014) Ethical considerations in quality assurance and evaluation activities. Available at https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/e111_ethical_considerations_in_quality_assurance_140326.pdf [Verified 23 November 2016]

NPS MedicineWise (2016) Clinical e-audits: privacy and confidentiality. Available at https://activities.nps.org.au/ClinicalAudit/Home/Privacy [Verified 23 November 2016]

Ong S, Nakase J, Moran GJ, Karras DJ, Kuehnert MJ, Talan DA, EMERGEncy ID NET Study Group (2007) Antibiotic use for emergency department patients with upper respiratory infections: prescribing practices, patient expectations, and patient satisfaction. Annals of Emergency Medicine 50, 213–220.
Antibiotic use for emergency department patients with upper respiratory infections: prescribing practices, patient expectations, and patient satisfaction.CrossRef |

Radyowijati A, Haak H (2003) Improving antibiotic use in low-income countries: an overview of evidence on determinants. Social Science & Medicine 57, 733–744.
Improving antibiotic use in low-income countries: an overview of evidence on determinants.CrossRef |

Shapiro E (2002) Injudicious antibiotic use: an unforeseen consequence of the emphasis on patient satisfaction? Clinical Therapeutics 24, 197–204.
Injudicious antibiotic use: an unforeseen consequence of the emphasis on patient satisfaction?CrossRef |

Tashima L, Piccirillo JF (2014) Are antibiotics indicated for acute sinusitis? The Laryngoscope 124, 1979–1980.
Are antibiotics indicated for acute sinusitis?CrossRef |

van der Velden A, Duerden MG, Bell J, Oxford JS, Altiner A, Kozlov R, Sessa A, Pignatari AC, Essack SY (2013) Prescriber and patient responsibilities in treatment of acute respiratory tract infections – essential for conservation of antibiotics. Antibiotics 2, 316–327.
Prescriber and patient responsibilities in treatment of acute respiratory tract infections – essential for conservation of antibiotics.CrossRef | 1:CAS:528:DC%2BC3sXhtVSktbrM&md5=65f4a69e8ae5f97f3a5ed029331c6657CAS |

White C (2004) If it doesn’t work, stop it: summary of rapid responses. British Medical Journal 328, 1016
If it doesn’t work, stop it: summary of rapid responses.CrossRef |

Wong DM, Blumberg DA, Lowe LG (2006) Guidelines for the use of antibiotics in acute upper respiratory tract infections. American Family Physician 74, 956–966.

World Health Organization (2001) World Health Organisation Global Strategy for Containment of Antimicrobial Resistance. WHO, Geneva, Switzerland.

World Health Organization (2011) World Health Day – 7 April 2011. Antimicrobial resistance and its global spread. WHO, Geneva, Switzerland.

Yox S, Scudder L (2014) Too many antibiotics! Patients and prescribers speak up. WebMD/Medscape Special Report. (WebMD/Medscape) Available at http://www.medscape.com/features/slideshow/public/antibiotic-misuse [Verified 15 August 2017]


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