Infectious disease management in primary care: perceptions of GPs

Abstract

Background: It is important to keep the level of antibiotic prescribing low to contain the development of resistant bacteria. This study was conducted to reveal new knowledge about how GPs think in relation to the prescribing of antibiotics - knowledge that could be used in efforts toward rational treatment of infectious diseases in primary care. The aim was to explore and describe the variations in GPs' perceptions of infectious disease management, with special reference to antibiotic prescribing.

Methods: Twenty GPs working at primary care centres in a county in south-west Sweden were purposively selected based on the strategy of including GPs with different kinds of experience. The GPs were interviewed and perceptions among GPs were analysed by a phenomenographic approach.

Results: Five qualitatively different perceptions of infectious disease management were identified. They were: (A) the GP must help the patient to achieve health and well-being; (B) the management must meet the GP's perceived personal, professional and organisational demands; (C) restrictive antibiotic prescribing is time-consuming; (D) restrictive antibiotic prescribing can protect the effectiveness of antibiotics; and (E) patients benefit personally from restrictive antibiotic prescribing.

Conclusions: Restrictive antibiotic prescribing was considered important in two perceptions, was not an issue as such in two others, and was considered in one perception although the actual prescribing was greatly influenced by the interaction between patient and GP. Accordingly, to encourage restrictive antibiotic prescribing several aspects must be addressed. Furthermore, different GPs need various kinds of support. Infectious disease management in primary care is complex and time-consuming, which must be acknowledged in healthcare organisation and planning.

Figure 1

The outcome space. The outcome space describes the relationships among the categories of description. Here categories are presented in a hierarchical order at four levels. Dominating aspects in the five categories of description were: A) the health and well-being of the patient; the duty of the GP to help patients, B) the GP's personal and professional experiences and expectations; perceived organizational demands, C) restrictive antibiotic prescribing should be considered; the general public is ignorant of common infectious diseases; restrictive antibiotic practice is time-consuming; D) the risk of non-effective antibiotics in the future is a reality; antibiotic use leads to resistant bacteria; patients and GPs must stand some discomfort for the sake of the future, and E) antibiotics have impact on patients' immunological resistance; patients with common infections who refrain from antibiotics are strengthened in the long run.