Is there a conflict between general practitioners applying guidelines for antibiotic prescribing and including their patients’ preferences?

Abstract

Anne EM Brabers,1 Thamar EM Van Esch,1 Peter P Groenewegen,1–3 Karin Hek,1 Pé Mullenders,4 Liset Van Dijk,1 Judith D De Jong11NIVEL, the Netherlands Institute for Health Services Research, Utrecht, 2Department of Sociology, Utrecht University, Utrecht, 3Department of Human Geography, Utrecht University, Utrecht, 4The National Health Care Institute, Diemen, the NetherlandsObjectives: One perceived barrier to guideline adherence is the existence of conflicting patient preferences. We examined whether patient preferences influence the prescription of antibiotics in general practice, and how this affects guideline adherence. We hypothesized that preferences play a larger role in prescribing antibiotics if the guideline allows for preferences to be taken into account, ie, if prescribing antibiotics is an option which can be considered rather than a clear recommendation to prescribe or not. We included three guidelines: acute cough, acute rhinosinusitis, and urinary tract infections.Methods: Data from NIVEL (the Netherlands Institute for Health Services Research) Primary Care Database (NIVEL-PCD) were used to assess antibiotic indications and prescriptions. These data were combined with a questionnaire among members of NIVEL’s Dutch Health Care Consumer Panel to examine patient preferences. According to NIVEL-PCD, 286 of these members contacted their general practitioner (GP) in 2015 for acute cough, acute rhinosinusitis or urinary tract infections. A logistic multilevel regression analysis was performed to test our hypothesis.Results: Patient preferences do play a role in GPs’ prescribing of antibiotics only in situations where, in accordance with the guideline, their use is an option which could be considered (interaction between indication and preference: p=0.049). If patients ask for antibiotics themselves in such situations, then GPs prescribe antibiotics more often.Conclusion: Patient preferences only play a role if the guideline provides room to take preferences into account. Therefore, our results do not suggest a conflict between applying guidelines and including patient preferences. Further research is recommended to examine this possible conflict in other situations.Keywords: antibiotics, clinical practice guidelines, medical practice variation, patient preferences

Keywords

• antibiotics
• clinical practice guidelines
• medical practice variation
• patient preferences