UNDERSTANDING THE CULTURE OF PRESCRIBING - QUALITATIVE STUDY OF GENERAL-PRACTITIONERS AND PATIENTS PERCEPTIONS OF ANTIBIOTICS FOR SORE THROATS

Objectives: To better understand reasons for antibiotics being prescri bed for sore throats despite well known evidence that they are general ly of little help. Design: Qualitative study with semi-structured inte rviews. Setting: General practices in South Wales. Subjects: 21 genera l practitioners and 17 of their patients who had recently consulted fo r a sore throat or upper respiratory tract infection. Main outcome mea sures: Subjects' experience of management of the illness, patients' ex pectations, beliefs about antibiotic treatment for sore throats, and i deas for reducing prescribing. Results: Doctors knew of the evidence f or marginal effectiveness yet often prescribed for good relationships with patients Possible patient benefit outweighed theoretical communit y risk from resistant bacteria. Most doctors found prescribing ''again st the evidence'' uncomfortable and realised this probably increased w orkload, Explanations of the distinction between virus and bacterium o ften led to perceived confusion. Clinicians were divided on the value of leaflets and national campaigns, but several favoured patient empow erment for self care by other members of the primary care team. Patien t expectations were seldom made explicit, and many were not met A thir d of patients had a clear expectation for antibiotics, and mothers wer e more likely to accept non-antibiotic treatment for their children th an for themselves. Satisfaction was not necessarily related to receivi ng antibiotics, with many seeking reassurance, further information, an d pain relief. Conclusions: This prescribing decision is greatly influ enced by considerations of the doctor-patient relationship. Consulting strategies that make patient expectations explicit without damaging r elationships might reduce unwanted antibiotics. Repeating evidence for lack or effectiveness is unlikely to change doctors' prescribing, but information about risk to individual patients might. Emphasising posi tive aspects of non-antibiotic treatment and lack of efficacy in gener al might be helpful.