Aims. This paper is a report of a qualitative study of the experiences of nurse prescribers in managing patients with self-limiting respiratory tract infections. Background. Patients frequently attend primary care with respiratory tract... more
Aims. This paper is a report of a qualitative study of the experiences of nurse prescribers in managing patients with self-limiting respiratory tract infections.
Background. Patients frequently attend primary care with respiratory tract infections. Although a no-prescribing strategy is recommended for these consultations, general practitioners frequently prescribe antibiotics, citing non-clinical reasons such as patient pressure. Nurses increasingly manage people with respiratory tract infections, but research has not yet explored their experiences within such consultations.
Methods. Fifteen semi-structured interviews and three focus groups (n = 5, n = 4, and n = 12) with a purposive sample of nurse prescribers (n = 34) and other nonmedical prescribers (n = 2) were conducted between November 2009 and November 2010. A qualitative approach was used to develop conceptual categories from the dataset, and emerging themes were explored in subsequent interviews/focus groups.
Findings. Although participants reported experiencing numerous challenges within these consultations, they believed that they possessed some of the communication skills to deal effectively with patients without prescribing antibiotics. Participants reported that protocols supported their decision-making and welcomed the benefits of peer support in dealing with demanding’ patients. However, the newness of nurses and other non-medical prescribers to the prescribing role meant that some were cautious in dealing with patients with respiratory tract infections.
Conclusion. Training for nurses and other non-medical prescribers should focus on building their confidence and skills to manage people with respiratory tract infections without recourse to antibiotics. Further work should seek to explore which strategies are most effective in managing respiratory tract infections while maintaining patient satisfaction with care.
Background: The emergence and spread of resistance related to the irrational use of antibiotics is a major global public health problem. The aim of this study was to assess Knowledge, Attitude and Practices towards use of unprescribed... more
Background: The emergence and spread of resistance related to the irrational use of antibiotics is a major global public health problem. The aim of this study was to assess Knowledge, Attitude and Practices towards use of unprescribed drugs among adults in a selected city of Somaliland. Methods: This study used cross-sectional survey and data was collected through semi-structured questionnaire. A purposive sampling of 400 individuals was obtained; Slovene’s Formula was used to calculate the sample size & Data was analysed by using SSPS v.20 and Ms Excel. Results: It is found that 64.3% of the respondents used any form of medicine without a medical practitioner's prescription. It is found that there is a significant association between respondent's level of knowledge and practice of unprescribed drug use. Conclusion: The conclusion is that it is important to formulate policies and strategies for drug distribution and sales aimed for controlling the public use of unprescribed drugs. Keywords : Knowledge; attitude and practice; antibiotics; unprescribed drugs; adults; Somaliland.
Background: The overuse of antimicrobials is recognized as the main selective pressure driving the emergence and spread of antimicrobial resistance in human bacterial pathogens. Urinary tract infections (UTIs) are among the most common... more
Background: The overuse of antimicrobials is recognized as the main selective pressure driving the emergence and spread of antimicrobial resistance in human bacterial pathogens. Urinary tract infections (UTIs) are among the most common infections presented in primary care and empirical antimicrobial treatment is currently recommended. Previous research has identified that a substantial proportion of Irish general practitioners (GPs) prescribe antimicrobials for UTIs that are not in accordance with the Guidelines for Antimicrobial Prescribing in Primary Care in Ireland. The aim of this trial is to design, implement and evaluate the effectiveness of a complex intervention on GP antimicrobial prescribing and adult (18 years of age and over) patients’ antimicrobial consumption when presenting with a suspected UTI. Methods/design: The Supporting the Improvement and Management of Prescribing for urinary tract infections (SIMPle) study is a three-armed intervention with practice-level randomization. Adult patients presenting with suspected UTIs in primary care will be included in the study. The intervention integrates components for both GPs and patients. For GPs the intervention includes interactive workshops, audit and feedback reports and automated electronic prompts summarizing recommended first-line antimicrobial treatment and, for one intervention arm, a recommendation to consider delayed antimicrobial treatment. For patients, multimedia applications and information leaflets are included. Thirty practices will be recruited to the study; laboratory data indicate that 2,038 patients will be prescribed an antimicrobial in the study. The primary outcome is a change in prescribing of first-line antimicrobials for UTIs in accordance with the Guidelines for Antimicrobial Prescribing in Primary Care in Ireland. The study will take place over 15 months with a six-month intervention period. Data will be collected through a remote electronic anonymized data-extraction system, a text-messaging system and GP and patient interviews and surveys. The intervention will be strengthened by the implementation of a social marketing framework and an economic evaluation.
BackgroundInterventions to promote prudent antibiotic prescribing by general practitioners (GPs) have often only been developed for use in one country. We aimed to develop an intervention which would be appropriate to implement in... more
BackgroundInterventions to promote prudent antibiotic prescribing by general practitioners (GPs) have often only been developed for use in one country. We aimed to develop an intervention which would be appropriate to implement in multiple European countries in order to offer greater benefit to practice whilst using fewer resources. The INTRO (INternet TRaining for antibiOtic use) intervention needed to deliver training to GPs in the use of C-Reactive Protein (CRP) near patient tests to help diagnose acute cough and in communication skills to help explain prescribing decisions to patients. We explored GPs’ views on the initial version of INTRO to test acceptability and potentially increase applicability for use in multiple countries before the start of a randomised trial.Method30 GPs from five countries (Belgium, England, the Netherlands, Poland and Spain), were interviewed using a “think aloud” approach. GPs were asked to work through the intervention and discuss their views on the...
Objectives: To empirically classify the etiology of URTI; to study the prescription pattern for antibiotics in URTI; and to analyze the necessity and adequacy of prescribed therapy. Study design: Observational non analytical... more
Objectives: To empirically classify the etiology of URTI; to study the prescription pattern for antibiotics in URTI; and to analyze the necessity and adequacy of prescribed therapy. Study design: Observational non analytical cross-sectional study. Study sites: Two community pharmacies located in Almada and in Elvas. Study population: Patients with an antibiotic prescription for a URTI (self use) and age greater than or equal to 18 years. Methods: Clinical and therapeutic data were collected during patient observation performed by a training pharmacist, and complemented with information collected through a questionnaire administered face-to-face to patients meeting the inclusion criteria and agreeing to participate. Empirical classifications were developed, one to ascertain the probability of URTI, based on Centor criteria, and another, to judge the need for antibiotic therapy, based on additional criteria considering subpopulations known to be at higher risk. Data was analyzed using the software SPSS, version 20.0. Results: The sample included 22 patients (27.3% recruited in Almada and 72.7% in Elvas). The most frequently prescribed antibiotic class was macrolides (54.5%), followed by penicillins (36.4%). In the first group, clarithromycin prevailed (66.7%) and in the second group, the more common was the association amoxicillin/clavulanic acid (75%). Considering the empirical classification developed, it was estimated that only one patient (4.5%) presented signs and symptoms suggestive of URTI with probable bacterial aetiology, and only three patients (13.6%) had an indication for antimicrobial therapy. Conclusion: The majority of patients observed were classified as having infections with apparently non-bacterial aetiology, for which the prescription of antibiotic would have been probably needless. This alerts to the overuse of antibiotics in the community setting, particularly for URTI, and its contribution to resistance.
Background: Improving good practice in antibiotics use is critical in challenging antimicrobial resistance. This study assessed knowledge and practices regarding antibiotic prescribing in children by physicians in both public and private... more
Background: Improving good practice in antibiotics use is critical in challenging antimicrobial resistance. This study assessed knowledge and practices regarding antibiotic prescribing in children by physicians in both public and private health care in Goma, East of the Democratic Republic of Congo, a low-income country. Methods: A cross-sectional study using self-administered questionnaires was applied. Results: 147 physicians from twenty-five health care providers in the city of Goma participated in the study. More than three-quarters [85.7% (n=147] were General Practitioners from primary health care settings. More than two-thirds of the participants had over five years' experience. In approximately three-quarters of cases [72.1%, (n=147)], the participants declared lack of recent training on antibiotic prescribing. In the five clinical situations posed to the participants, antibiotics prescribing practice was felt to be inappropriate or unnecessary in 15 to 80%. Antibiotic prescribing for symptoms of cough and fever, yellowish sputum, odynophagia, cold and flu and fever, positive "Thick smear" test and fever were categorized as unnecessary or inappropriate. An incorrect response concerning the susceptibility of Staphylococcus Methicillin-Resistant (MRSA) was demonstrated in more than three-quarters in General Practitioners [76.4%, (n=123)] compared to less than half in Specialists [41.2%, (n=123)] (p=0.00). With regard to Enterococcus susceptibility, an incorrect response was noted in more than three-quarters in both General Practitioners and Specialists. A number of internal factors or determinants in health care institutions (Publics and Privates sectors) were noted to restrict good practice in antibiotics prescribing. Factors contributing to poor to practice in antibiotics prescribing were the uncertainty in the diagnosis, physicians who had only practiced in private hospitals and clinics and frequent antibiotics stock shortage in public or semi-public hospital. In more than a third of physicians, antibiotics resistance was not perceived as a problem in their daily practice or as a public health problem. Conclusions: Hospitals in Goma demonstrated inappropriate antibiotic prescribing practice. Strategies and policies such as Antimicrobial Stewardship and socio-anthropological approach need to be explored.
Abstract Patients with self-limiting respiratory tract infections (RTIs) are frequently seen in general practice. Although antibiotics are ineffective for these conditions, they are often prescribed by general practitioners (GPs), and... more
Abstract Patients with self-limiting respiratory tract infections (RTIs) are frequently seen in general practice. Although antibiotics are ineffective for these conditions, they are often prescribed by general practitioners (GPs), and perceived patient expectations for an antibiotic plays an important role in the decision to prescribe one. Superfluous use of antibiotics contributes to antimicrobial resistance. High numbers of nurse prescribers work alongside GPs and these prescribers see education and self-management advice as central to the care of these patients. Multi-faceted interventions, designed to reduce antibiotic prescribing, only exist for GPs. Such interventions should foster interprofessional collaboration and, as such, consider the needs and experiences of the different prescribers, and the views of patients. This paper outlines a research study in which a questionnaire will be distributed to patients who consult with a nurse prescriber to see whether their expectations influence their satisfaction with the consultation outcome. Findings will guide the development of an interprofessional intervention designed to promote collaborative practice and appropriate and responsible antibiotic prescribing in primary care.
