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The Article in Brief
Managing Expectations of Antibiotics for Upper Respiratory Tract Infections: A Qualitative Study
Mohammed Mustafa , and colleagues
Background A number of studies have looked at doctor visits in which antibiotics are expected by patients or parents but may not be indicated by the clinical findings. There have been few efforts, however, to ask family physicians about the ways in which they handle expectations for antibiotics. This study explores how and why family physicians elicit and address patient or parents' expectations for antibiotics in visits for upper respiratory tract infections.
What This Study Found Family physicians prefer not to explore patient expectations for antibiotics in a direct manner or early on in visits for upper respiratory tract infections, contrary to the advice of many communications experts. Clinicians prefer more indirect methods to explore treatment expectations in an effort to avoid conflict and potential threats to the ongoing physician-patient relationship and trust. They report using open questions and building a foundation for nonantibiotic management by using strategies to indicate their reasoning and influence expectations, including running commentary on physical examination findings.
Implications
- The authors suggest that interventions to promote appropriate antibiotic prescribing include a focus on training in communication skills that integrates indirect methods as a part of building collaborative physician-patient relationships and uses the running commentary of examination findings to facilitate participation in clinical decisions.
Annals Journal Club
Jan/Feb 2014: Managing Expectations for Antibiotics When Seeing Patients With Upper Respiratory Tract Infections
The Annals of Family Medicine encourages readers to develop a learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club and sharing the results of your discussions in the Annals online discussion for the featured articles. RADICAL is an acronym for Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. The word radical also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care and then acting on those discussions.1
HOW IT WORKS
In each issue, the Annals selects an article or articles and provides discussion tips and questions. We encourage you to take a RADICAL approach to these materials and to post a summary of your conversation in our online discussion. (Open the article online and click on "TRACK Comments: Submit a response.") You can find discussion questions and more information online at: http://www.AnnFamMed.org/site/AJC/.
CURRENT SELECTION
Article for Discussion
- Mustafa M, Wood F, Butler CC, Elwyn G. Managing expectations of antibiotics for upper respiratory tract infections: a qualitative study. Ann Fam Med. 2014;12(1):29-36.
Discussion Tips
This study uses qualitative methods to try to tap into the wisdom of experienced family physicians for their strategies to reduce inappropriate antibiotic prescribing by managing expectations. The article presents an opportunity to develop subtlety in practice.
Discussion Questions
- What question is asked by this study and why does it matter?
- How does this study advance beyond previous research and clinical practice on this topic?
- How strong is the study design for answering the question?
- To what degree can the findings be accounted for by the following2
- How participants were selected? (Did the authors achieve saturation? That is, did they sample until the point at which no new information was obtained from further sampling?)
- How the data were collected?
- Preconceptions on the part of the investigators?
- How the findings were analyzed and interpreted?
- The theoretical framework used to guide the investigation?
- What are the main study findings?
- How relevant is the study sample to you and your practice? Does it matter that the physicians are not a representative sample? What is your judgment about the transferability of the findings to your setting?
- What contextual factors are important for interpreting the findings?
- How might this study change your practice? Policy? Education? Research?
- Who are the constituencies for the findings, and how they might be engaged in interpreting or using the findings?
- What are the next steps in interpreting or applying the findings?
- What researchable questions remain?
References
- Stange KC, Miller WL, McLellan LA, et al. Annals Journal Club: It's time to get RADICAL. Ann Fam Med. 2006;4(3):196-197.
- Malterud K. Qualitative research: standards, challenges, and guidelines. Lancet. 2001;358(9280):483-488.