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Antibiotics for acute respiratory tract infections: a mixed-methods study of patient experiences of non-medical prescriber management
  1. Molly Courtenay1,
  2. Samantha Rowbotham2,3,
  3. Rosemary Lim4,
  4. Rhian Deslandes5,
  5. Karen Hodson5,
  6. Katie MacLure6,
  7. Sarah Peters7,
  8. Derek Stewart6
  1. 1School of Healthcare Sciences, Cardiff University, Cardiff, UK
  2. 2Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia
  3. 3The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales, Australia
  4. 4Reading School of Pharmacy, Reading, UK
  5. 5Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
  6. 6School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
  7. 7Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK
  1. Correspondence to Dr Molly Courtenay; courtenaym{at}cardiff.ac.uk

Abstract

Objective To (1) explore patients' expectations and experiences of nurse and pharmacist non-medical prescriber-led management of respiratory tract infections (RTIs), (2) examine whether patient expectations for antibiotics affect the likelihood of receiving them and (3) understand factors influencing patient satisfaction with RTI consultations.

Design Mixed methods.

Setting Primary care.

Participants Questionnaires from 120 patients and follow-up interviews with 22 patients and 16 nurse and pharmacist non-medical prescribers (NMPs).

Results Patients had multiple expectations of their consultation with 43% expecting to be prescribed an antibiotic. There was alignment between self-reported patient expectations and those perceived by NMPs. Patient expectations for non-antibiotic strategies, such as education to promote self-management, were associated with receipt of those strategies, whereas patient expectations for an antibiotic were not associated with receipt of these medications. ‘Patient-centred’ management strategies (including reassurance and providing information) were received by 86.7% of patients. Regardless of patients' expectations or the management strategy employed, high levels of satisfaction were reported for all aspects of the consultation. Taking concerns seriously, conducting a physical examination, communicating the treatment plan, explaining treatment decisions and lack of time restrictions were each reported to contribute to patient satisfaction.

Conclusions NMPs demonstrate an understanding of patient expectations of RTI consultations and use a range of non-antibiotic management strategies, particularly those resembling a patient-centred approach. Overall, patients' expectations were met and prescribers were not unduly influenced by patient expectations for an antibiotic. Patients were satisfied with the consultation, indicating that strategies used by NMPs were acceptable. However, the lower levels of satisfaction among patients who expected but did not receive an antibiotic indicates that although NMPs appear to have strategies for managing RTI consultations, there is still scope for improvement and these prescribers are therefore an important group to involve in antimicrobial stewardship.

  • RESPIRATORY MEDICINE (see Thoracic Medicine)

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Footnotes

  • Contributors MC made a substantial contribution to the conception and design of the work; the acquisition and interpretation of data, and drafting of the work. SR made a substantial contribution to the design of the work, the acquisition, analysis and interpretation of data, and drafting of the work. RL made a substantial contribution to the acquisition, analysis and interpretation of data, and critically revised drafts of the work. SP made a substantial contribution to the design of the work, the interpretation of data, and critically revised drafts of the work. DS, KM, KH and RD each made a substantial contribution to the acquisition and interpretation of data, and critically revised drafts of the work. All authors approved the final version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This research was funded by a research grant from Sanofi. The researchers were completely independent of the funders.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval NRES Committee London—City Road and Hampstead and Cardiff University Ethics Committee (REC reference 14/LO/0480).

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

  • Data sharing statement No additional data are available.

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