The decision-making process in general practice of when to use antibiotics to treat acute rhinosinusitis
Author
Christensen, Thomas Victor
Term
5. Term (Master thesis)
Education
Publication year
2024
Submitted on
2024-01-04
Pages
23
Abstract
In Danish primary care, most antibiotics are prescribed, and a large share is for upper respiratory tract infections such as acute rhinosinusitis (ARS, sinus infection). This study aimed to understand how general practitioners (GPs) and doctors in training decide whether to use antibiotics for ARS. In autumn 2023, 73 practices were invited; 10 doctors took part, and 9 semi-structured interviews were conducted. Data were analyzed using Systematic Text Condensation, a qualitative method for synthesizing interview data. Four themes emerged: patient management, diagnosis, treatment, and concern about future antibiotic resistance. Diagnosing ARS was relatively straightforward, but distinguishing bacterial from viral infections remained difficult. C-reactive protein (CRP), a blood test for inflammation, was often used in decision-making but was not considered fully reliable. When deciding on antibiotics, doctors weighed benefits, risks, side effects, immunosuppression, comorbidity, medical history, and age. Antibiotics were rarely needed at first, but various factors could influence the decision. Educating patients sometimes made it easier for them to accept the doctor’s decision and reduced interest in antibiotics. The study concludes that patient expectations, insistence, and the doctor–patient relationship could shape decisions and sometimes led to inappropriate antibiotic prescribing. Developing clinical prediction rules and guidelines may help, and further research on CRP use in ARS could benefit general practice.
I dansk almen praksis udskrives de fleste antibiotika, og en stor del bruges til øvre luftvejsinfektioner som akut rhinosinuitis (ARS, bihulebetændelse). Denne undersøgelse havde til formål at forstå, hvordan praktiserende læger og uddannelseslæger beslutter, om patienter med ARS skal have antibiotika. I efteråret 2023 blev 73 praksis inviteret til at deltage; 10 læger medvirkede, og der blev gennemført 9 semistrukturerede interviews. Data blev analyseret med Systematisk Tekstkondensering, en kvalitativ metode til at sammenfatte interviewdata. Fire temaer trådte frem: patienthåndtering, diagnostik, behandling og bekymring for fremtidig antibiotikaresistens. Det var forholdsvis let at stille ARS-diagnosen, men svært at afgøre, om infektionen var bakteriel eller viral. C-reaktivt protein (CRP), en blodprøve for betændelse, blev ofte brugt i beslutningsprocessen, men blev ikke anset som helt pålidelig. Lægerne afvejede blandt andet fordele, risici, bivirkninger, immunsuppression, komorbiditet, sygehistorie og alder. Antibiotika var sjældent nødvendigt i starten, men forskellige forhold kunne påvirke beslutningen. Patientundervisning gjorde det nogle gange lettere for patienterne at forstå lægens valg og kunne mindske ønsket om antibiotika. Konklusionen var, at patientforventninger, insisteren og relationen mellem læge og patient kunne præge beslutningerne og til tider føre til uhensigtsmæssig antibiotikabehandling. Udvikling af kliniske beslutningsregler og retningslinjer kan støtte lægernes vurderinger, og mere forskning i brugen af CRP ved ARS kan være nyttig i almen praksis.
[This apstract has been rewritten with the help of AI based on the project's original abstract]
Keywords