uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
Interacting factors associated with Low antibiotic prescribing for respiratory tract infections in primary health care - a mixed methods study in Sweden
Lund Univ, Dept Clin Sci Malmo Family Med, Malmo, Sweden.;Blekinge Cty Council, Blekinge Ctr Competence, Karlskrona, Sweden..
Lund Univ, Dept Clin Sci Malmo Family Med, Malmo, Sweden.;Ctr Primary Hlth Care Res, Malmo, Skane Region, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Linkoping Univ, Dept Med & Hlth Sci Family Med, Linkoping, Sweden..
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Sociology.
Show others and affiliations
2016 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 17, 78Article in journal (Refereed) PublishedText
Abstract [en]

Background: Prescribing of antibiotics for common infections varies widely, and there is no medical explanation. Systematic reviews have highlighted factors that may influence antibiotic prescribing and that this is a complex process. It is unclear how factors interact and how the primary care organization affects diagnostic procedures and antibiotic prescribing. Therefore, we sought to explore and understand interactions between factors influencing antibiotic prescribing for respiratory tract infections in primary care. Methods: Our mixed methods design was guided by the Triangulation Design Model according to Creswell. Quantitative and qualitative data were collected in parallel. Quantitative data were collected by prescription statistics, questionnaires to patients, and general practitioners' audit registrations. Qualitative data were collected through observations and semi-structured interviews. Results: From the analysis of the data from the different sources an overall theme emerged: A common practice in the primary health care centre is crucial for low antibiotic prescribing in line with guidelines. Several factors contribute to a common practice, such as promoting management and leadership, internalized guidelines including inter-professional discussions, the general practitioner's diagnostic process, nurse triage, and patient expectation. These factors were closely related and influenced each other. The results showed that knowledge must be internalized and guidelines need to be normative for the group as well as for every individual. Conclusions: Low prescribing is associated with adapted and transformed guidelines within all staff, not only general practitioners. Nurses' triage and self-care advice played an important role. Encouragement from the management level stimulated inter-professional discussions about antibiotic prescribing. Informal opinion moulders talking about antibiotic prescribing was supported by the managers. Finally, continuous professional development activities were encouraged for up-to-date knowledge.

Place, publisher, year, edition, pages
2016. Vol. 17, 78
Keyword [en]
Mixed methods design, Antibiotic prescribing, Guidelines, Implementation, Primary care
National Category
Family Medicine
URN: urn:nbn:se:uu:diva-300448DOI: 10.1186/s12875-016-0494-zISI: 000379800700003PubMedID: 27430895OAI: oai:DiVA.org:uu-300448DiVA: diva2:951524
Public Health Agency of Sweden
Available from: 2016-08-09 Created: 2016-08-09 Last updated: 2016-08-09Bibliographically approved

Open Access in DiVA

fulltext(735 kB)39 downloads
File information
File name FULLTEXT01.pdfFile size 735 kBChecksum SHA-512
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
André, MalinGröndal, Hedvig
By organisation
Family Medicine and Preventive MedicineDepartment of Sociology
In the same journal
BMC Family Practice
Family Medicine

Search outside of DiVA

GoogleGoogle Scholar
Total: 39 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 117 hits
ReferencesLink to record
Permanent link

Direct link