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Why do general practitioners prescribe antibiotics for upper respiratory tract infections to meet patient expectations: a mixed methods study
  1. Stephanie Fletcher-Lartey1,
  2. Melissa Yee2,
  3. Christina Gaarslev3,
  4. Rabia Khan4
  1. 1Population Health, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
  2. 2Evaluation, NPS MedicineWise, Sydney, New South Wales, Australia
  3. 3Oslo kommune Helseetaten, Oslo, Norway
  4. 4Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Rabia Khan; rabia.khan{at}


Objectives To describe the role patient expectations play in general practitioners (GPs) antibiotic prescribing for upper respiratory tract infections (URTI).

Methods Concurrent explanatory mixed methods approach using a cross-sectional survey and semistructured interviews.

Settings Primary care GPs in Australia.

Participants 584 GPs (response rate of 23.6%) completed the cross-sectional survey. 32 GPs were interviewed individually.

Outcome measure Prescribing of antibiotics for URTI.

Results More than half the GP respondents to the survey in Australia self-reported that they would prescribe antibiotics for an URTI to meet patient expectations. Our qualitative findings suggest that ‘patient expectations’ may be the main reason given for inappropriate prescribing, but it is an all-encompassing phrase that includes other reasons. These include limited time, poor doctor–patient communication and diagnostic uncertainty. We have identified three role archetypes to explain the behaviour of GPs in reference to antibiotic prescribing for URTIs. The main themes emerging from the qualitative component was that many GPs did not think that antibiotic prescribing in primary care was responsible for the development of antibiotic resistance nor that their individual prescribing would make any difference in light of other bigger issues like hospital prescribing or veterinary use. For them, there were negligible negative consequences from their inappropriate prescribing.

Conclusions There is a need to increase awareness of the scope and magnitude of antibiotic resistance and the role primary care prescribing plays, and of the contribution of individual prescribing decisions to the problem of antibiotic resistance.

  • upper respiratory tract infection
  • antibiotics
  • inappropriate prescribing

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  • Twitter Follow Stephanie Fletcher-Lartey at @stephjewels and Rabia Khan at @rabiaikhan

  • Contributors SF-L designed the qualitative component of the study, collected and analysed the data, and drafted the manuscript. MY codesigned the study, analysed the quantitative component of the study and critically revised the manuscript. CG provided substantial contributions to the data acquisition and analysis of the quantitative component of the study, interpretation of the data and drafting of the manuscript. RK was a principal investigator on the study and contributed to the design of the study and analysis of the findings as well as to the writing of the manuscript.

  • Funding This research was funded by the Australian Department of Health through NPS MedicineWise. We also acknowledge the contribution of Vanessa Simpson and Margie Campbell for their advice during project development, and Suzanne Blogg and Lynn Weekes for their thoughtful contribution to editing this article.

  • Competing interests None declared.

  • Ethics approval Royal Australasian College of General Practice National Research and Evaluation Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Extra data can be accessed via the Dryad data repository at with the doi:10.5061/dryad.gt76v.