"I'm Dr Jekyll and Mr Hyde": are GPs' antibiotic prescribing patterns contextually dependent? A
qualitative focus group study.
Sammanfattning
Objective. To explore factors and circumstances contributing to prudent antibiotic prescribing for
respiratory tract infections in primary care. Design. Two focus groups representing rural and urban
areas. A semi-structured interview guide with open-ended questions and an editing analysis style
was used. They were examined to identify meaning units that were sorted into categories in an
iterative process throughout the analysis. Setting. Primary health care in two counties in southern
Sweden. Subjects. Two groups including seven and six general practitioners (GPs) respectively, men
and women of different ages with different professional experiences. Main outcome measures.
Exploration of categories, determination of themes, construction of models. Results. The decision to
prescribe antibiotics takes place in the encounter between GP and patient, initially characterized by
harmony or fight and the subsequent process by collaboration or negotiation, resulting in agreement,
compromise, or disagreement. Several factors influence the meeting and contribute to enhancing the
conditions for rational prescribing. These conditions are connected to the GP, the relationship, and
the setting; organization as well as professional culture. The findings indicate synergies between the
factors, and that one factor can sometimes compensate for lack of another. Continuity and mutual
trust can make a brief consultation successful, but lack of continuity can eliminate the effects of
knowledge and professional skills. Conclusions. The findings emphasize the importance of the
encounter between the GP and the patient for prudent antibiotic prescribing. Furthermore, the
importance of an appropriate organization of primary care, which promotes continuity and
encourages professional autonomy, is demonstrated.