Antibiotic Prescribing and Doctor-Patient Communication During Consultations for Respiratory Tract Infections: A Video Observation Study in Out-of-Hours Primary Care

Annelies Colliers; Katrien Bombeke; Hilde Philips; Roy Remmen; Samuel Coenen; Sibyl Anthierens

doi:10.3389/fmed.2021.735276

Antibiotic Prescribing and Doctor-Patient Communication During Consultations for Respiratory Tract Infections: A Video Observation Study in Out-of-Hours Primary Care

Front Med (Lausanne). 2021 Dec 1:8:735276. doi: 10.3389/fmed.2021.735276. eCollection 2021.

Authors

Annelies Colliers¹, Katrien Bombeke², Hilde Philips¹, Roy Remmen¹, Samuel Coenen^{1

3}, Sibyl Anthierens¹

Affiliations

¹ Department of Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium.
² Skills Laboratory, University of Antwerp, Antwerp, Belgium.
³ Vaccine and Infectious Disease Institute (VAXINFECTIO)-Laboratory of Medical Microbiology, University of Antwerp, Antwerp, Belgium.

Abstract

Objective: Communication skills can reduce inappropriate antibiotic prescribing, which could help to tackle antibiotic resistance. General practitioners often overestimate patient expectations for an antibiotic. In this study, we describe how general practitioners and patients with respiratory tract infections (RTI) communicate about their problem, including the reason for encounter and ideas, concerns, and expectations (ICE), and how this relates to (non-)antibiotic prescribing in out-of-hours (OOH) primary care. Methods: A qualitative descriptive framework analysis of video-recorded consultations during OOH primary care focusing on doctor-patient communication. Results: We analyzed 77 videos from 19 general practitioners. General practitioners using patient-centered communication skills received more information on the perspective of the patients on the illness period. For some patients, the reason for the encounter was motivated by their belief that a general practitioner (GP) visit will alter the course of their illness. The ideas, concerns, and expectations often remained implicit, but the concerns were expressed by the choice of words, tone of voice, repetition of words, etc. Delayed prescribing was sometimes used to respond to implicit patient expectations for an antibiotic. Patients accepted a non-antibiotic management plan well. Conclusion: Not addressing the ICE of patients, or their reason to consult the GP OOH, could drive assumptions about patient expectations for antibiotics early on and antibiotic prescribing later in the consultation.

Keywords: antibiotics; communication; general practice; out-of-hours care; primary care; reason for encounter; respiratory tract infections; video observation.