چکیده (انگلیسی):

Background:Prescribing of antibiotics for common infections varies widely, and there is no medical explanation.
Systematic reviews have highlighted factors that may influence antibiotic prescribing and that this is a complex
process. It is unclear how factors interact and how the primary care organization affects diagnostic procedures and
antibiotic prescribing. Therefore, we sought to explore and understand interactions between factors influencing
antibiotic prescribing for respiratory tract infections in primary care.
Methods:Our mixed methods design was guided by the Triangulation Design Model according to Creswell.
Quantitative and qualitative data were collected in parallel. Quantitative data were collected by prescription
statistics, questionnaires to patients, and general practitioners’ audit registrations. Qualitative data were collected
through observations and semi-structured interviews.
Results:From the analysis of the data from the different sources an overall theme emerged: A common practice in
the primary health care centre is crucial for low antibiotic prescribing in line with guidelines. Several factors
contribute to a common practice, such as promoting management and leadership, internalized guidelines
including inter-professional discussions, the general practitioner’s diagnostic process, nurse triage, and patient
expectation. These factors were closely related and influenced each other. The results showed that knowledge must
be internalized and guidelines need to be normative for the group as well as for every individual.
Conclusions:Low prescribing is associated with adapted and transformed guidelines within all staff, not only
general practitioners. Nurses’ triage and self-care advice played an important role. Encouragement from the
management level stimulated inter-professional discussions about antibiotic prescribing. Informal opinion moulders
talking about antibiotic prescribing was supported by the managers. Finally, continuous professional development
activities were encouraged for up-to-date knowledge.