Antibiotic Negotiations: Conversation Analytic Pilot (ANCAP)

Conference:

SAPC ASM 2018 - London

Talk Code:

1E.1

Presenter:

Catherine J. Woods

Twitter:

@CatJWoods

Co-authors:

Dr. R.K. Barnes, Dr. F. Stevenson, Dr. K. Postle, Mrs J. Seely, Dr. S. Tonkin-Crine, Dr. C. Eyles, Prof. M. Moore, Prof. P. Little, and Prof. G.M. Leydon

Author institutions:

University of Southampton, University of Bristol, University College London, University of Oxford

Problem

Antimicrobial Resistance (henceforth AMR) is an increasing and serious threat to public health. In the UK, 80% of antibiotic prescribing occurs in primary care, with over half for respiratory tract infections (RTIs). There is growing evidence that clinician-patient/parent communication plays a significant role in prescribing decisions and is an important research focus; and that antimicrobial stewardship programmes that incorporate elements to support ‘clear communication’ about symptoms and treatment are more likely to influence and promote prudent antibiotic prescribing practices. However, existing evidence about the challenges associated with antibiotic prescribing has largely been derived from self-reported methods (e.g. questionnaires and interviews) and theoretically-informed notions of what constitutes ‘clear’/’effective’ communication. Observational research based on large samples of practitioner-patient communication about antibiotics is needed to understand prescribing practices in-detail and the full range of communicative challenges that influence prescribing decisions.

Approach

ANCAP is a qualitative, conversation analytic study of a large a corpus of video-recorded GP-patient consultations in which the need for antibiotics was discussed/negotiated. The overall dataset comprises of consultations for suspected urological, gastrological, skin infections; but the most frequent problem presented was for respiratory problems and these were the focus of analyses. The research used the principles of Conversation Analysis (henceforth CA) to understand patterns in communication and the predominant communicative behaviours that influenced antibiotic prescribing decisions. Emerging findings were discussed with PPI representatives in a group meeting in Southampton.

Findings

Analyses are still on-going until May 2018. In this presentation we discuss: 1) the main formats GPs use to recommend antibiotics and ‘no treatment’ (e.g. self-care advice only, wait and see); 2) the interactional resources patients use to ‘resist’ (i.e. challenge) the treatment recommendation; and 3) the implications of this resistance upon the clinical outcome (e.g. whether the outcome changed).

Consequences

This is the first UK-based observational study about how GPs and patients communicate about antibiotics during routine appointments. It provided new and important understandings about the communicative factors that influence prescribing decisions which will form the basis of communication skills training practitioners can use in the future. These findings will also be used in a future SPCR-funded observational study to compare how the communicative factors identified in routine consultations compare to the challenges associated with prescribing during out-of-hours medical care.

Submitted by:

Catherine J. Woods

Funding acknowledgement:

The team would like to thank CLARHC-Wessex for funding the pilot of this study in 2017; and the School for Primary Care Research for funding the main study.