Exploring general practitioners' perception of the value of natural history information and their awareness and use of guidelines' resources to support antibiotic prescribing for self-limiting infections: a qualitative study in Australian general practice

Background: The newest version of the Therapeutic Guidelines' antibiotic chapter introduced patient- and clinician-facing resources to support decision-making about antibiotic use for self-limiting infections. It is unclear whether general practitioners (GPs) are aware of and use these resources, including the natural history information they contain. We explored GPs' perceptions of the value and their use of natural history information, and their use of the Therapeutic Guidelines' resources (summary table, discussion boxes, decision aids) to support antibiotic decision-making. Methods: Semi-structured interviews with 21 Australian GPs were conducted. Interviews were recorded, transcribed and thematically analysed by two independent researchers. Results: Four themes emerged: (1) GPs perceive natural history information as valuable in consultations for self-limiting conditions and use it for a range of purposes, but desire specific information for infectious and non-infectious conditions; (2) GPs' reasons for using patient-facing resources were manifold, including managing patients' expectations for antibiotics, legitimising the decision not to provide antibiotics and as a prescription substitute; (3) the guidelines are a useful and important educational resource, but typically not consulted at the time of deciding whether to prescribe antibiotics; and (4) experience and attitude towards shared decision-making and looking up information during consultations influenced whether GPs involved patients in decision-making and used a decision aid. Conclusions: GPs perceived natural history information to be valuable in discussions about antibiotic use for self-limiting conditions. Patient and clinician resources were generally perceived as useful, although reasons for use varied, and a few barriers to use were reported. Many acute infections improve spontaneously, and awareness of the natural history of such infections underpins community antibiotic stewardship clinical strategies. This study explored GPs' awareness and views about using natural history information when consulting about self-limiting infections. We noted that GPs generally support using natural history information in consultations for self-limiting conditions, and do so variably and for various reasons. However, improved ready access to such information may facilitate its use. [ABSTRACT FROM AUTHOR]

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