The decision-making process in general practice of when to use antibiotics to treat acute rhinosinusitis

Abstract

Purpose: The Danish primary care sector makes up most of the antibiotic prescriptions and upper respiratory tract infections (URTI), such as acute rhinosinusitis (ARS), account for a large part of it. The main purpose of the study was to explore the decision-making process of when to use antibiotics to treat patients with ARS, among general practitioners (GPs) and doctors in training (DIT) who worked in general practices. Methods: In autumn 2023, 73 general practices were physically delivered an invitation for participation in the study. A total of 10 doctors were recruited and 9 semi-structured interviews were conducted. Systematic Text Condensation (SCT) was used to analyze data. Results: Four analytical themes were developed: management of the patient, diagnosing the patient, treatment of the patient and future development of antibiotic resistance. Diagnosing ARS was fairly simple but distinguishing whether the infection was bacterial or viral remained challenging. C- reactive protein (CRP) was often used in the decision-making process but was not considered a completely trustworthy biomarker. Considerations when deciding to treat with antibiotics were benefits, risks, side effects, immunosuppression, comorbidity, medical history, and age. Antibiotics were rarely necessary at first but different factors could sometimes influence the decision. Patient education occasionally made it easier for the patients to understand the doctors’ decisions and sometimes resulted in the patients not being interested in antibiotic treatment after all. Conclusion: Factors such as patient expectations, insistence and doctor-patient relationship could influence the decision-making process and sometimes resulted in antibiotics being prescribed inappropriately. Developing clinical prediction rules and guidelines might help the doctors in their considerations of which patients will benefit the most from antibiotic treatment. Future research on whether CRP is appropriate to use for this group of patients may be beneficial for the doctors in general practices.

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A master thesis from Aalborg University

The decision-making process in general practice of when to use antibiotics to treat acute rhinosinusitis