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Antibiotics for acute respiratory tract infections: a mixed-methods study of patient experiences of non-medical prescriber management.

Courtenay, Molly; Rowbotham, Samantha; Lim, Rosemary; Deslandes, Rhian; Hodson, Karen; MacLure, Katie; Peters, Sarah; Stewart, Derek C.

Authors

Molly Courtenay

Samantha Rowbotham

Rosemary Lim

Rhian Deslandes

Karen Hodson

Katie MacLure

Sarah Peters

Derek C. Stewart

Abstract

Objective: To (1) explore patients' expectations and experiences of nurse and pharmacist non-medical prescriber-led management of respiratory tract infections (RTIs), (2) examine whether patient expectations for antibiotics affect the likelihood of receiving them and (3) understand factors influencing patient satisfaction with RTI consultations. Design: Mixed methods. Setting: Primary care. Participants: Questionnaires from 120 patients and follow-up interviews with 22 patients and 16 nurse and pharmacist non-medical prescribers (NMPs). Results: Patients had multiple expectations of their consultation with 43% expecting to be prescribed an antibiotic. There was alignment between self-reported patient expectations and those perceived by NMPs. Patient expectations for non-antibiotic strategies, such as education to promote self-management, were associated with receipt of those strategies, whereas patient expectations for an antibiotic were not associated with receipt of these medications. 'Patientcentred' management strategies (including reassurance and providing information) were received by 86.7% of patients. Regardless of patients' expectations or the management strategy employed, high levels of satisfaction were reported for all aspects of the consultation. Taking concerns seriously, conducting a physical examination, communicating the treatment plan, explaining treatment decisions and lack of time restrictions were each reported to contribute to patient satisfaction. Conclusions: NMPs demonstrate an understanding of patient expectations of RTI consultations and use a range of non-antibiotic management strategies, particularly those resembling a patient-centred approach. Overall, patients' expectations were met and prescribers were not unduly influenced by patient expectations for an antibiotic. Patients were satisfied with the consultation, indicating that strategies used by NMPs were acceptable. However, the lower levels of satisfaction among patients who expected but did not receive an antibiotic indicates that although NMPs appear to have strategies for managing RTI consultations, there is still scope for improvement and these prescribers are therefore an important group to involve in antimicrobial stewardship.

Journal Article Type Article
Publication Date Mar 15, 2017
Journal BMJ open
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 7
Issue 3
Article Number e013515
Institution Citation COURTENAY, M., ROWBOTHAM, S., LIM, R., DESLANDES, R., HODSON, K., MACLURE, K., PETERS, S. and STEWART, D. 2017. Antibiotics for acute respiratory tract infections: a mixed-methods study of patient experiences of non-medical prescriber management. BMJ open [online], 7(3), e013515. Available from: https://doi.org/10.1136/bmjopen-2016-013515
DOI https://doi.org/10.1136/bmjopen-2016-013515
Keywords Nonmedical prescriber led management; Respiratory tract infections; Patient satisfaction; Primary care; Antibiotic

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