Barriers and facilitators to prudent antibiotic prescribing for acute respiratory tract infections: A qualitative study with general practitioners in Malta

Erika A Saliba-Gustafsson, Anna Nyberg, Michael A Borg, Senia Rosales-Klintz, Cecilia Stålsby Lundborg, Erika A Saliba-Gustafsson, Anna Nyberg, Michael A Borg, Senia Rosales-Klintz, Cecilia Stålsby Lundborg

Abstract

Background: Antibiotic resistance is a leading global public health concern and antibiotic use is a key driver. Effective interventions are needed to target key stakeholders, including general practitioners (GPs). In Malta, little is known about factors that influence GPs' antibiotic prescribing, making it challenging to implement targeted interventions. We therefore aimed to explore GPs' understanding of antibiotic use and resistance, and describe their perceived barriers and facilitators to prudent antibiotic prescribing for acute respiratory tract infections in Malta.

Methods: Face-to-face individual semi-structured interviews were held with a quota sample of 20 GPs in 2014. Interviews were audio recorded and transcribed verbatim, and later analysed iteratively using manifest and latent content analysis. Findings were collated in a socioecological model to depict how GPs as individuals are embedded within larger social systems and contexts, and how each component within this system impacts their prescribing behaviour.

Findings: We found that GPs' antibiotic prescribing decisions are complex and impacted by numerous barriers and facilitators at the individual, interpersonal, organisational, community, and public policy level. Predominant factors found to impact GPs' antibiotic prescribing included not only intrinsic GP factors such as knowledge, awareness, experience, and misconceptions, but also several external factors. At the interpersonal level, GPs' perceived patient demand and behaviour to be a persistent issue that impacts their prescribing decisions. Similarly, some GPs found pressure from drug reps to be concerning despite being considered an important source of information. Organisational and public policy-level issues such as lack of access to relevant antibiotic prescribing guidelines and current antibiotic resistance data from the community, were also considered major barriers to appropriate antibiotic prescribing. Utilisation of diagnostic testing was found to be low and GPs' perceptions on the introduction of rapid point-of-care tests to support antibiotic prescription decisions, were mixed.

Conclusion: This study revealed the complexity of the antibiotic prescribing decision and the numerous barriers and facilitators that impact it, visualised through a socioecological model. Addressing GPs' antibiotic prescribing practices will require targeted and coordinated implementation activities at all levels to change behaviour and address misconceptions, whilst also improving the physical and social environment.

Trial registration number: NCT03218930; https://ichgcp.net/clinical-trials-registry/NCT03218930.

Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: At the time of the study, SRK was employed at Karolinska Institutet, Sweden. She is currently employed by the European Centre for Disease Prevention and Control (ECDC). The views and opinions expressed herein are the authors’ own and do not necessarily state or reflect those of ECDC. ECDC is not responsible for the data and information collation and analysis and cannot be held liable for conclusions or opinions drawn. EASG, AN, MAB and CSL have no competing interests to declare.

Figures

Fig 1. Overview of barriers and facilitators…
Fig 1. Overview of barriers and facilitators identified to have an impact on GPs’ antibiotic prescribing at all levels of the socioecological model.

References

    1. World Health Organization; Global action plan on antimicrobial resistance. Geneva, Switzerland: WHO; 2015.
    1. Cassini A, Diaz Högberg L, Plachouras D, Quattrocchi A, Hoxha A, Skov Simonsen G, et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect Dis. 2019;19(1):56–66. 10.1016/S1473-3099(18)30605-4
    1. Bell BG, Schellevis F, Stobberingh E, Goossens H, Pringle M. A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance. BMC Infect Dis. 2014;14:13 10.1186/1471-2334-14-13
    1. Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ. 2010;340:c2096 10.1136/bmj.c2096
    1. Goossens H, Ferech M, Vander Stichele R, Elseviers M, ESAC Project Group. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005;365(9459):579–587. 10.1016/S0140-6736(05)17907-0
    1. European Centre for Disease Prevention and Control. Surveillance of antimicrobial consumption in Europe, 2013–2014. Stockholm, Sweden: ECDC; 2018.
    1. Gulliford MC, Prevost AT, Charlton J, Juszczyk D, Soames J, McDermott L, et al. Effectiveness and safety of electronically delivered prescribing feedback and decision support on antibiotic use for respiratory illness in primary care: REDUCE cluster randomised trial. BMJ. 2019;364:1236 10.1136/bmj.l236
    1. Gulliford MC, Moore MV, Little P, Hay AD, Fox R, Prevost AT, et al. Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records. BMJ. 2016;354:i3410 10.1136/bmj.i3410
    1. Meropol SB, Localio AR, Metlay JP. Risks and benefits associated with antibiotic use for acute respiratory infections: a cohort study. Ann Fam Med. 2013;11(2):165–172. 10.1370/afm.1449
    1. Butler CC, Hood K, Verheij T, Little P, Melbye H, Nuttall J, et al. Variation in antibiotic prescribing and its impact on recovery in patients with acute cough in primary care: prospective study in 13 countries. BMJ. 2009;338:b2242 10.1136/bmj.b2242
    1. Little P, Watson L, Morgan S, Williamson I. Antibiotic prescribing and admissions with major suppurative complications of respiratory tract infections: a data linkage study. Br J Gen Pract. 2002;52(476):187–193.
    1. O’Connor R, O’Doherty J, O’Regan A, Dunne C. Antibiotic use for acute respiratory tract infections (ARTI) in primary care; what factors affect prescribing and why is it important? A narrative review. Ir J Med Sci. 2018;187(4):969–986. 10.1007/s11845-018-1774-5
    1. McKay R, Mah A, Law MR, McGrail K, Patrick DM. Systematic review of factors associated with antibiotic prescribing for respiratory tract infections. Antimicrob Agents Chemother. 2016;60(7):4106–4118. 10.1128/AAC.00209-16
    1. Borg MA. National cultural dimensions as drivers of inappropriate ambulatory care consumption of antibiotics in Europe and their relevance to awareness campaigns. J Antimicrob Chemother, 2012;67(3):763–767. 10.1093/jac/dkr541
    1. Deschepper R, Grigoryan L, Stålsby Lundborg C, Hofstede G, Cohen J, Van Der Kelen G, et al. Are cultural dimensions relevant for explaining cross-national differences in antibiotic use in Europe? BMC Health Serv Res. 2008;8:123 10.1186/1472-6963-8-123
    1. Howick J, Cals JW, Jones C, Price CP, Plüddermann A, Heneghan C, et al. Current and future use of point-of-care tests in primary care: an international survey in Australia, Belgium, The Netherlands, the UK and the USA. BMJ Open 2014;4(8):e005611 10.1136/bmjopen-2014-005611
    1. McDonagh MS, Peterson K, Winthrop K, Cantor A, Lazur BH, Buckley DI. Interventions to reduce inappropriate prescribing of antibiotics for acute respiratory tract infections: summary and update of a systematic review. J Int Med Res, 2018;46(8):3337–3357. 10.1177/0300060518782519
    1. Tonkin-Crine SK, Tan PS, van Hecke O, Wang K, Roberts NW, McCullough A, et al. Clinician-targeted interventions to influence antibiotic prescribing behaviour for acute respiratory infections in primary care: an overview of systematic reviews. Cochrane Database Syst Rev. 2017;9(9):CD012252 10.1002/14651858.CD012252.pub2
    1. Bernier A, Delarocque-Astagneau E, Ligier C, Vibet MA, Guillemot D, Watier L. Outpatient antibiotic use in France between 2000 and 2010: after the nationwide campaign, it is time to focus on the elderly. Antimicrob Agents Chemother. 2014;58(1):71–77. 10.1128/AAC.01813-13
    1. Formoso G, Paltrinieri B, Marata AM, Gagliotti C, Pan A, Moro ML, et al. Feasibility and effectiveness of a low cost campaign on antibiotic prescribing in Italy: community level, controlled, non-randomised trial. BMJ. 2013;347:f5391 10.1136/bmj.f5391
    1. Chahwakilian P, Huttner B, Schlemmer B, Harbarth S. Impact of the French campaign to reduce inappropriate ambulatory antibiotic use on the prescription and consultation rates for respiratory tract infections. J Antimicrob Chemother. 2011;66(12):2872–2879. 10.1093/jac/dkr387
    1. Huttner B, Goossens H, Verheij T, Harbarth S, CHAMP consortium. Characteristics and outcomes of public campaigns aimed at improving the use of antibiotics in outpatients in high-income countries. Lancet Infect Dis. 2010;10(1):17–31. 10.1016/S1473-3099(09)70305-6
    1. TNS Opinion & Social. Special eurobarometer 478: antimicrobial resistance. Brussels, Belgium: European Commission; 2018.
    1. TNS Opinion & Social. Special eurobarometer 445: antimicrobial resistance. Brussels, Belgium: European Commission; 2016.
    1. TNS Opinion & Social. Special eurobarometer 407: antimicrobial resistance. Brussels, Belgium: European Commission; 2013.
    1. Saliba-Gustafsson EA, Dunberger Hampton A, Zarb P, Borg MA, Stålsby Lundborg C. Antibiotic prescribing for respiratory tract complaints in Malta: a 1 year repeated cross-sectional surveillance study. J Antimicrob Chemother. 2019;74(4):1116–1124. 10.1093/jac/dky544
    1. Zarb P, Borg MA. Consumption of antibiotics within ambulatory care in Malta. Malta Med J. 2011;23(2):13–18.
    1. Saliba-Gustafsson EA, Borg MA, Rosales-Klintz S, Nyberg A, Stålsby Lundborg C. Maltese Antibiotic Stewardship Programme in the Community (MASPIC): protocol of a prospective quasiexperimental social marketing intervention. BMJ Open. 2017;7(9):e017992 10.1136/bmjopen-2017-017992
    1. Azzopardi-Muscat N, Buttigieg S, Calleja N, Merkur S. Malta: health system review. Health Syst Transit. 2017;19(1):1–137.
    1. PricewaterhouseCoopers. Healthcare delivery in Malta. Malta: PricewaterhouseCoopers; 2012.
    1. Borg MA, Scicluna EA. Over-the-counter acquisition of antibiotics in the Maltese general population. Int J Antimicrob Agents. 2002;20(4):253–257. 10.1016/s0924-8579(02)00194-2
    1. Mack N, Woodsong C, MacQueen KM, Guest G, Namey E. Qualitative research methods: a data collector’s field guide. North Carolina, USA: FHI; 2005.
    1. Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107–115. 10.1111/j.1365-2648.2007.04569.x
    1. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–112. 10.1016/j.nedt.2003.10.001
    1. McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q. 1988;15(4):351–377. 10.1177/109019818801500401
    1. Golden SD, Earp JAL. Social ecological approaches to individuals and their contexts: twenty years of health education & behavior health promotion interventions. Health Educ Behav. 2012;39(3):364–372. 10.1177/1090198111418634
    1. Germeni E, Frost J, Garside R, Rogers M, Valderas JM, Britten N. Antibiotic prescribing for acute respiratory tract infections in primary care: an updated and expanded meta-ethnography. Br J Gen Pract. 2018;68(674):e633–645. 10.3399/bjgp18X697889
    1. Björkman I, Berg J, Viberg N, Stålsby Lundborg C. Awareness of antibiotic resistance and antibiotic prescribing in UTI treatment: a qualitative study among primary care physicians in Sweden. Scand J Prim Health Care. 2013;31(1):50–55. 10.3109/02813432.2012.751695
    1. Simpson SA, Wood F, Butler CC. General practitioners’ perceptions of antimicrobial resistance: a qualitative study. J Antimicrob Chemother. 2007;59(2):292–296. 10.1093/jac/dkl467
    1. Zoorob R, Sidani MA, Fremont RD, Kihlberg C. Antibiotic use in acute upper respiratory tract infections. Am Fam Physician. 2012;86(9):817–822.
    1. Hendaus MA, Jomha FA, Alhammadi AH. Virus-induced secondary bacterial infection: a concise review. Ther Clin Risk Manag. 2015;11:1265–1271. 10.2147/TCRM.S87789
    1. Wald ER, Applegate KE, Bordley C, Darrow DH, Glode MP, Marcy SM, et al. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics. 2013;132(1):e262–280. 10.1542/peds.2013-1071
    1. National Institute for Health and Care Excellence. Respiratory tract infections (self-limiting): prescribing antibiotics. London, UK: NICE; 2008.
    1. Saliba-Gustafsson EA, Dunberger Hampton A, Zarb P, Orsini N, Borg MA, Stålsby Lundborg C. Factors associated with antibiotic prescribing in patients with acute respiratory tract complaints in Malta: a 1-year repeated cross-sectional surveillance study. BMJ Open. 2019;9(12):e032704 10.1136/bmjopen-2019-032704
    1. Dallas A, Magin P, Morgan S, Tapley A, Henderson K, Ball J, et al. Antibiotic prescribing for respiratory infections: a cross-sectional analysis of the ReCEnT study exploring the habits of early-career doctors in primary care. Fam Pract. 2015;32(1):49–55. 10.1093/fampra/cmu069
    1. Dekker ARJ, Verheij TJM, van der Velden AW. Inappropriate antibiotic prescription for respiratory tract indications: most prominent in adult patients. Fam Pract. 2015;32(4):401–407. 10.1093/fampra/cmv019
    1. Haeseker MB, Dukers-Muijrers NHTM, Hoebe CJPA, Bruggeman CA, Cals JWL, Verbon A. Trends in antibiotic prescribing in adults in Dutch general practice. PLoS One. 2012;7(12):e51860 10.1371/journal.pone.0051860
    1. Rosman S, Le Vaillant M, Schellevis F, Clerc P, Verheij R, Pelletier-Fleury N. Prescribing patterns for upper respiratory tract infections in general practice in France and in the Netherlands. Eur J Public Health. 2008;18(3):312–316. 10.1093/eurpub/ckm118
    1. Akkerman AE, van der Wouden JC, Kuyvenhoven MM, Dieleman JP, Verheij TJM. Antibiotic prescribing for respiratory tract infections in Dutch primary care in relation to patient age and clinical entities. J Antimicrob Chemother. 2004;54(6):1116–1121. 10.1093/jac/dkh480
    1. Stanton N, Hood K, Kelly MJ, Huttall J, Gillespie D, Verheij T, et al. Are smokers with acute cough in primary care prescribed antibiotics more often, and to what benefit? An observational study in 13 European countries. Eur Respir J. 2010;35:761–767. 10.1183/09031936.00168409
    1. Manne M, Deshpande A, Hu B, Patel A, Taksler GB, Misra-Hebert AD, et al. Provider variation in antibiotic prescribing and outcomes of respiratory tract infections. South Med J. 2018;111(4):235–242. 10.14423/SMJ.0000000000000795
    1. Shallcross L, Beckley N, Rait G, Hayward A, Petersen I. Antibiotic prescribing frequency amongst patients in primary care: a cohort study using electronic health records. J Antimicrob Chemother. 2017;72(6):1818–1824. 10.1093/jac/dkx048
    1. Dempsey PP, Businger AC, Whaley LE, Gagne JJ, Linder JA. Primary care clinicians’ perceptions about antibiotic prescribing for acute bronchitis: a qualitative study. BMC Fam Pract. 2014;15:194 10.1186/s12875-014-0194-5
    1. Coenen S, Francis N, Kelly M, Hood K, Nuttall J, Little P, et al. Are patient views about antibiotics related to clinician perceptions, management and outcome? A multi-country study in outpatients with acute cough. PLoS One. 2013;8(10):e76691 10.1371/journal.pone.0076691
    1. Frich JC, Høye S, Lindbaek M, Straand J. General practitioners and tutors’ experiences with peer group academic detailing: a qualitative study. BMC Fam Pract. 2010;11(12). 10.1186/1471-2296-11-12
    1. Akkerman AE, Kuyvenhoven MM, van der Wouden JC, Verheij TJM. Determinants of antibiotic overprescribing in respiratory tract infections in general practice. J Antimicrob Chemother. 2005;56(5):930–966. 10.1093/jac/dki283
    1. Cockburn J, Pit S. Prescribing behaviour in clinical practice: patients’ expectations and doctors’ perceptions of patients’ expectations: a questionnaire study. BMJ. 1997;315(7107):520–523. 10.1136/bmj.315.7107.520
    1. Little P, Dorward M, Warner G, Stephens K, Senior J, Moore M. Importance of patient pressure and perceived pressure and perceived medical need for investigations, referral, and prescribing in primary care: nested observational study. BMJ. 2004;328(7437):444 10.1136/bmj.38013.644086.7C
    1. Murphy M, Byrne S, Bradley CP. Influence of patient payment on antibiotic prescribing in Irish general practice: a cohort study. Br J Gen Pract. 2011;61(590):e549–555. 10.3399/bjgp11X593820
    1. Ashworth M, White P, Jongsma H, Schofield P, Armstrong D. Antibiotic prescribing and patient satisfaction in primary care in England: cross-sectional analysis of national patient survey data and prescribing data. Br J Gen Pract. 2016;66(642):e40–46. 10.3399/bjgp15X688105
    1. Thoolen B, de Ridder D, van Lensvelt-Mulders G. Patient-oriented interventions to improve antibiotic prescribing practices in respiratory tract infections: a meta-analysis. Health Psychol Rev. 2012;6(1):92–112.
    1. van Duijn HJ, Kuyvenhoven MM, Schellevis FG, Verheij TJM. Illness behaviour and antibiotic prescription in patients with respiratory tract symptoms. Br J Gen Pract. 2007;57(54):561–568.
    1. Welschen I, Kuyvenhoven M, Hoes A, Verheij T. Antibiotics for acute respiratory tract symptoms: patients’ expectations, GPs’ management and patient satisfaction. Fam Pract. 2004;21(3):234–237. 10.1093/fampra/cmh303
    1. Butler CC, Rollnick S, Pill R, Maggs-Rapport F, Stott N. Understanding the culture of prescribing: qualitative study of general practitioners’ and patients’ perceptions of antibiotics for sore throats. BMJ. 1998;317(7159):637–642. 10.1136/bmj.317.7159.637
    1. Mangione-Smith R, McGlynn EA, Elliott MN, Krogstad P, Brook RH. The relationship between perceived parental expectations and pediatrician antimicrobial prescribing behavior. Pediatrics. 1999;103(4 Pt 1):711–718. 10.1542/peds.103.4.711
    1. Spurling GK, Mansfield PR, Montgomery BD, Lexchin J, Doust J, Othman N, et al. Information from pharmaceutical companies and the quality, quantity, and cost of physicians’ prescribing: a systematic review. PLoS Med. 2010;7(10):e1000352 10.1371/journal.pmed.1000352
    1. Prosser H, Almond S, Walley T. Influences on GPs’ decision to prescribe new drugs-the importance of who says what. Fam Pract. 2003;20(1):61–68. 10.1093/fampra/20.1.61
    1. Watkins C, Harvey I, Carthy P, Moore L, Robinson E, Brawn R. Attitudes and behaviour of general practitioners and their prescribing costs: a national cross sectional survey. Qual Saf Health Care. 2003;12(1):29–34. 10.1136/qhc.12.1.29
    1. Fickweiler F, Fickweiler W, Urbach E. Interactions between physicians and the pharmaceutical industry generally and sales representatives specifically and their association with physicians’ attitudes and prescribing habits: a systematic review. BMJ Open. 2017;7(9):e016408 10.1136/bmjopen-2017-016408
    1. Fernández-Álvarez I, Zapata-Cachafeiro M, Vázquez-Lago J, López-Vázquez P, Piñeiro-Lamas M, García Rodríguez R, et al. Pharmaceutical companies information and antibiotic prescription patterns: a follow-up study in Spanish primary care. PLoS One. 2019;14(8):e0221326 10.1371/journal.pone.0221326
    1. Muijrers PE, Grol RP, Sijbrandij J, Janknegt R, Knottnerus A. Differences in prescribing between GPs: impact of the cooperation with pharmacists and impact of visits from pharmaceutical industry representatives. Fam Pract. 2005;22(6):624–630. 10.1093/fampra/cmi074
    1. Borg MA, Camilleri L. Broad-spectrum antibiotic use in Europe: more evidence of cultural influences on prescribing behaviour. J Antimicrob Chemother. 2019;74(11):3379–3383. 10.1093/jac/dkz312
    1. O’Brien MA, Rogers S, Jamtvedt G, Oxman AD, Odgaard-Jensen J, Kristoffersen DT, et al. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2007;2007(4):CD000409 10.1002/14651858.CD000409.pub2
    1. Dyrkorn R, Gjelstad S, Espnes KA, Lindbæk M. Peer academic detailing on use of antibiotics in acute respiratory tract infections. A controlled study in an urban Norwegian out-of-hours service. Scand J Prim Health Care. 2016;34(2):180–185. 10.3109/02813432.2016.1163035
    1. Ilett KF, Johnson S, Greenhill G, Mullen L, Brockis J, Golledge CL, et al. Modification of general practitioner prescribing of antibiotics by use of a therapeutics adviser (academic detailer). Br J Clin Pharmacol. 2000;49(2):168–173. 10.1046/j.1365-2125.2000.00123.x
    1. Gaygısız Ü, Lajunen T, Gaygısız E. Socio-economic factors, cultural values, national personality and antibiotics use: a cross-cultural study among European countries. J Infect Public Health. 2017;10(6):755–760. 10.1016/j.jiph.2016.11.011
    1. Hofstede G, Hofstede G, Minkov M. Cultures and organisations: software of the mind (3rd ed). New York, USA: McGraw-Hill Education; 2010.
    1. Biezen R, Roberts C, Buising K, Thursky K, Boyle D, Lau P, et al. How do general practitioners access guidelines and utilise electronic medical records to make clinical decisions on antibiotic use? Results from an Australian qualitative study. BMJ Open. 2019;9(8):e028329 10.1136/bmjopen-2018-028329
    1. Carlsen B, Glenton C, Pope C. Thou shalt versus thou shalt not: a meta-synthesis of GPs’ attitudes to clinical practice guidelines. Br J Gen Pract. 2007;57(545):971–978. 10.3399/096016407782604820
    1. O’Neill J. Tackling drug-resistant infections globally: final report and recommendations. London, UK: Review on Antimicrobial Resistance; 2016.
    1. World Health Organization. The evolving threat of antimicrobial resistance: options for action. Geneva, Switzerland: WHO; 2012.
    1. Oppong R, Jit M, Smith RD, Butler CC, Melbye H, Mölstad S, et al. Cost-effectiveness of point-of-care C-reactive protein testing to inform antibiotic prescribing decisions. Br J Gen Pract. 2013;63(612):e465–471. 10.3399/bjgp13X669185
    1. Butler CC, Simpson S, Wood F. General practitioners’ perceptions of introducing near-patient testing for common infections into routine primary care: a qualitative study. Scand J Prim Health Care. 2008;26(1):17–21. 10.1080/02813430701726285
    1. Llor C, Bjerrum L, Munck A, Cots JM, Hernández S, Moragas A, et al. Access to point-of-care tests reduces the prescription of antibiotics among antibiotic-requesting subjects with respiratory tract infections. Respir Care. 2014;59(12):1918–1923. 10.4187/respcare.03275
    1. Anthierens S, Tonkin-Crine S, Douglas E, Fernandez-Vandellos P, Krawcyzk J, Llor C, et al. General practitioners’ views on the acceptability and applicability of a web-based intervention to reduce antibiotic prescribing for acute cough in multiple European countries: a qualitative study prior to a randomised trial. BMC Fam Pract. 2012;13:101 10.1186/1471-2296-13-101
    1. Klepser DG, Bisanz SE, Klepser ME. Cost-effectiveness of pharmacist-provided treatment of adult pharyngitis. Am J Manag Care. 2012;18(4):e145–154.
    1. de la Poza Abad M, Mas Dalmau G, Moreno Bakedano M, González González AI, Canellas Criado Y, Hernández Anadón S, et al. Prescription strategies in acute uncomplicated respiratory infections: a randomized clinical trial. JAMA Intern Med. 2016;176(1):21–29. 10.1001/jamainternmed.2015.7088
    1. Little P, Moore M, Kelly J, Williamson I, Leydon G, McDermott L, et al. Delayed antibiotic prescribing strategies for respiratory tract infections in primary care: pragmatic, factorial, randomised controlled trial. BMJ. 2014;348:g1606 10.1136/bmj.g1606
    1. Høye S, Frich JC, Lindbæk M. Use and feasibility of delayed prescribing for respiratory tract infections: a questionnaire survey. BMC Fam Pract. 2011;12:34 10.1186/1471-2296-12-34
    1. Little P, Rumsby K, Kelly J, Watson L, Moore M, Warner G, et al. Information leaflet and antibiotic prescribing strategies for acute lower respiratory tract infection: a randomized controlled trial. JAMA. 2005;293(24):3029–3035. 10.1001/jama.293.24.3029
    1. Dowell J, Pitkethly M, Bain J, Martin S. A randomised controlled trial of delayed antibiotic prescribing as a strategy for managing uncomplicated respiratory tract infection in primary care. Br J Gen Pract. 2001;51(464):200–205.
    1. Little P, Gould C, Williamson I, Moore M, Warner G, Dunleavey J. Pragmatic randomised controlled trial of two prescribing strategies for childhood acute otitis media. BMJ. 2001;322(7282):336–342. 10.1136/bmj.322.7282.336
    1. Cates C. An evidence based approach to reducing antibiotic use in children with acute otitis media: controlled before and after study. BMJ. 1999;318(7185):715–716. 10.1136/bmj.318.7185.715
    1. Little P, Williamson I, Warner G, Gould C, Gantley M, Kinmouth AL. Open randomised trial of prescribing strategies in managing sore throat. BMJ. 1997;314(7082):722–727. 10.1136/bmj.314.7082.722
    1. Saliba-Gustafsson EA, Röing M, Borg MA, Rosales-Klintz S, Stålsby Lundborg C. General practitioners’ perceptions of delayed antibiotic prescription for respiratory tract infections: a phenomenographic study. PLoS One. 2019;14(11):e0225506 10.1371/journal.pone.0225506
    1. McDermott L, Leydon GM, Halls A, Kelly J, Nagle A, White J, et al. Qualitative interview study of antibiotics and self-management strategies for respiratory infections in primary care. BMJ Open. 2017;7(11):e016903 10.1136/bmjopen-2017-016903
    1. Francis NA, Gillespie D, Nuttall J, Hood K, Little P, Verheij T, et al. Delayed antibiotic prescribing and associated antibiotic consumption in adults with acute cough. Br J Gen Pract. 2012;62(602):e639–646. 10.3399/bjgp12X653561
    1. Raft CF, Bjerrum L, Arpi M, Jarløv JO, Nygaard Jensen J. Delayed antibiotic prescription for upper respiratory tract infections in children under primary care: physicians’ views. Eur J Gen Pract. 2017;23(1):190–195. 10.1080/13814788.2017.1347628
    1. Peters S, Rowbotham S, Chisholm A, Weardon A, Moschogianis S, Cordingley L, et al. Managing self-limiting respiratory tract infections: a qualitative study of the usefulness of the delayed prescribing strategy. Br J Gen Pract. 2011;61(590):e579–589. 10.3399/bjgp11X593866
    1. Kumar S, Little P, Britten N. Why do general practitioners prescribe antibiotics for sore throat? Grounded theory interview study. BMJ. 2003;326(7381):138 10.1136/bmj.326.7381.138
    1. Arroll B, Goodyear-Smith F, Thomas DR, Kerse N. Delayed antibiotic prescriptions: what are the experiences and attitudes of physicians and patients? J Fam Pract. 2002;51(11):954–959.

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