Telephone prescribing of antibiotics - General practitioners' views and reflections

Background: In this era of increasing problems with resistance, rational pr escribing of antibiotics is extremely important. Therefore, rationales for prescribing require analyses. The objective of this study was to explore ge neral practitioners' (GPs') reasons for prescribing antibiotics by telephon e. Methods: Qualitative analysis of semistructured interviews with and obse rvations of GPs in Iceland enquiring about the rationale for prescribing an tibiotics was used. Ten GPs were interviewed for 45 min to 2 h each includi ng three who were observed between 3 and 10 h. Results: The GPs generally i ndicated a restrictive attitude to telephone prescribing, although they all gave examples of their prescribing by telephone. The prescribing was mostl y but not always based on some kind of diagnosis. The factors influencing d iagnosis and prescribing were largely non-clinical: knowledge of the patien ts as persons, including their complaint threshold, confidence in their des criptions, the GPs' communication strategies and the travelling distance be tween patients and GPs. The clinical factors were the patients' description of signs and symptoms and knowledge of their history. Prescriptions not ba sed on diagnosis were 'therapeutic trial' or GP-approved self-medication. S ometimes, the Us requested to see a patient even though the diagnosis was b ased on history, signs and symptoms. Conclusions: Multiple factors affected the decision-making process when antibiotics were prescribed by telephone, most of which were non-clinical. The diagnosis, if there was one, was gene rally presumptive. GPs' general attitudes correlated well with current know ledge but were contrasted by the reality of their daily work conditions.