Understanding antibiotic prescribing for respiratory tract infections in primary care out of hours services (The UNITE Study)
Respiratory tract infections (RTI) are usually brief, self-limiting conditions. Antibiotics have little or no clinical benefit in most cases, however RTIs account for over 80% of all antibiotic prescriptions issued in primary care. In addition to the risk of side effects, the unnecessary prescription of antibiotics contributes to the spread of resistant bacteria. Antibiotic resistance may have catastrophic consequences and tackling rising resistance has been highlighted as an international priority. From 2010 to 2013, the total number of annual prescriptions of antibiotics increased by 6%: general practice prescriptions increased by 4%, while other community prescriptions, including primary care out of hours (OOH) services, increased by 32%. Community prescribing is rapidly increasing and OOH services are likely to be a major contributor. The English Surveillance Programme for Antimicrobial Utilisation and Resistance has suggested that this increase in community prescriptions needed to be investigated, and understanding factors influencing prescribing in OOH may also enable the development of tailored interventions promoting optimal prescribing in this setting. In light of this, the study aims to explore medical and non-medical prescriber’s views on and experiences of facilitators and barriers to antibiotic prescribing for RTI in primary care OOH services.
Approximately 30-40 semi-structured qualitative interviews will be conducted to elicit General Practitioner (GP) and Nurse Prescriber (NP) views and experiences of prescribing for RTIs. To ensure diversity, purposive maximum variation and snowballing sampling will be used to identify key informants. A thematic analysis of transcribed interviews will be conducted. In line with the applied nature of the work proposed, a subtle-realist approach will be taken and standard approaches will be used to safeguard rigour.
Initial findings suggest that antibiotic prescribing in primary care OOH is influenced by patient characteristics and expectation, including narratives surrounding whether GPs and NPs prescribe antibiotics due to demand. Organisational and contextual factors include reduced access to patient records, and lack of time and interaction with OOH colleagues. GPs and NPs report that patients within this setting are more acutely ill, therefore suggesting that more antibiotics may be required than within in-hour general practice. Participant responses to potential training is positive provided it is varied in its delivery and provides regular updates on national and local guidelines.
The study findings will describe participant experiences of and views on prescribing antibiotics for RTI in primary care OOH services, including similarities and differences between NPs and GPs. The team will describe how findings compare with existing evidence on ‘in hour’ antibiotic prescribing for RTIs. The study will also explore NP and GP views on the need for a training intervention. If warranted, data generated from this project will be used to develop a training intervention to help improve prescribing behaviour in OOH services.