UNderstanding medIcal and non-medical anTibiotic prescribing for rEspiratory tract infections in primary care out of hours services: a qualitative analysis

Respiratory tract infections (RTIs) (cough, sore throat, sinusitis, ear infection, and cold) are usually short-lived and are rarely serious. Research shows that antibiotics are not very effective in treating RTI’s and people usually recover well without them. Still, antibiotics are often prescribed in primary care out of hours services (6.30pm-8am). This is not best practice because the overuse of antibiotics has been linked to bacterial resistance. To ensure we still have effective antibiotics in the future unnecessary prescribing needs to be reduced.

Delayed or ‘just in case’ prescribing of antibiotics can help reduce their use. This means the patient is offered a prescription but it is recommended they ‘delay’ taking it for a few days to allow the condition to improve on its own/take it if the condition worsens. The National Institute for Health and Care Excellence (NICE) recommend that health care professionals who prescribe use this approach. However, research has shown that some GPs and nurses do not like to use this ‘just in case’ approach. In most cases, no antibiotic is needed, but a delayed prescription is likely to provide benefits in comparison to an immediate antibiotic prescription. To date, research has looked at staff who work ‘in-hours’, usually between 7am-7pm.

The proposed study will conduct qualitative interviews with GPs and Nurse Prescribers (NPs) based in primary care out of hours (OOH) services to identify experiences of and views on prescribing antibiotics for RTI OOH. Findings will be used in a follow on study to develop and test new ways of managing their prescribing decisions to help reduce unnecessary antibiotic prescriptions.