University of Twente Student Theses

Social, Cultural and Personal Determinants of Antibiotic Prescribing for Upper Respiratory Tract Infections in West European Primary Care: A Systematic Review and In-Depth Interview Study

Batenburg, C. (2024) Social, Cultural and Personal Determinants of Antibiotic Prescribing for Upper Respiratory Tract Infections in West European Primary Care: A Systematic Review and In-Depth Interview Study.

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Abstract:	Background. Antibiotics are vital for healthcare, however, rising antibiotic resistance is posing a serious threat. This can be partly attributed to inappropriate prescribing. A significant portion of antibiotics are prescribed in primary care, particularly for upper respiratory tract infections (URTIs). This means that URTIs are prone to Potentially Inappropriate Prescribing (PIP). Therefore, this study explores the determinants that play a role in the decision-making process among general practitioners (GPs) and patients regarding antibiotic prescribing for URTIs in Western Europe. Methodology. A literature review was performed to identify determinants that play a role in the decision-making processes among GPs and patients regarding antibiotic prescribing for upper respiratory infections. The text of each included paper was firstly literally extracted. All results were then analysed again to extract a meaning beyond their literal sense to enable a more nuanced comparison of the results. To gain further insight, qualitative research has been conducted in the form of in-depth interviews. Interviews were conducted with three patients and two GPs from the Netherlands. During the interviews all questions were asked in the context of URTIs. Questions were asked about their experiences with antibiotics, their thoughts on antibiotics, and in the case of GPs, also about their approach to prescribing antibiotics. Data was analysed using Atlas.ti to identify possible other determinants. Results. An electronic search performed in March 2023, using databases PubMed and Scopus, resulted in 200 studies. After screenings, 13 studies met the inclusion criteria and were included in the review. Three determinants were found in the literature and confirmed by the in-depth interviews (IDIs): ‘Expectations’, ‘view on recovery’, ‘Relationship between patient and GP’. The determinants ‘Patient characteristics (age)’, ‘guideline non-adherence’, ‘time pressure’, Quick availability of diagnostic tests’ and ‘patient education’ were also found to play a role in the decision-making process of the GPs in either the literature or the IDIs. The determinants found in the literature and the IDIs did not always align, indicating a potential gap in the literature. Conclusion. This study identified determinants that play a role the decision-making process in antibiotic prescribing in primary care. By identifying these determinants, recommendations can be made about further research, exploration of other infections such as urinary tract infections and policy changes. They underscore the importance of considering social, cultural, and personal factors when it comes to writing interventions for antibiotic prescribing in URTIs. However, a recurring problem is time constraint, which is a difficult to solve in the current health climate and may decrease the effectiveness of potential solutions.
Item Type:	Essay (Master)
Faculty:	TNW: Science and Technology
Subject:	44 medicine
Programme:	Health Sciences MSc (66851)
Link to this item:	https://purl.utwente.nl/essays/98418
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