چکیده (انگلیسی):

Background:Clinicians prescribe antibiotics to over 65% of adults with acute bronchitis despite guidelines stating
that antibiotics are not indicated.
Methods:To identify and understand primary care clinician perceptions about antibiotic prescribing for acute
bronchitis, we conducted semi-structured interviews with 13 primary care clinicians in Boston, Massachusetts and
used thematic content analysis.
Results:All the participants agreed with guidelines that antibiotics are not indicated for acute bronchitis and felt
that clinicians other than themselves were responsible for overprescribing. Barriers to guideline adherence included
6 themes: (1) perceived patient demand, which was the main barrier, although some clinicians perceived a recent
decrease; (2) lack of accountability for antibiotic prescribing; (3) saving time and money; (4) other clinicians
misconceptions about acute bronchitis; (5) diagnostic uncertainty; and (6) clinician dissatisfaction in failing to meet
patient expectations. Strategies to decrease inappropriate antibiotic prescribing included 5 themes: (1) patient
educational materials; (2) quality reporting; (3) clinical decision support; (4) use of an over-the-counter prescription
pad; and (5) pre-visit triage and education by nurses to prevent visits.
Conclusions:Clinicians continued to cite patient demand as the main reason for antibiotic prescribing for acute
bronchitis, though some clinicians perceived a recent decrease. Clinicians felt that other clinicians were responsible
for inappropriate antibiotic prescribing and that better pre-visit triage by nurses could prevent visits and change
patientsexpectations.