| Widespread antibiotic use for acute respiratory infections has contributed significantly to the antibiotic resistance crisis. Recent studies indicate that over one-half of all antibiotics prescribed for acute respiratory infections in the U.S. are unwarranted. Further understanding of the antibiotic prescribing process is needed to guide us in our efforts to curtail inappropriate antibiotic prescribing. The purpose of this study was to generate a detailed description and theoretical analysis of how clinicians make antibiotic prescribing decisions for patients presenting with acute respiratory infections. Participants in this study were 21 primary health care clinicians, who were practicing in college health (n = 5), internal medicine (n = 5), family practice (n = 4), pediatrics (n = 4), and emergency medicine (n = 3) in a rural western U.S. community during February 2000. The study utilized a qualitative descriptive design informed by Grounded Theory. Formal, semi-structured, audiotaped interviews were conducted with each of the clinicians and analyzed using a comparative method of analysis. Using current adult and pediatric CDC-issued antibiotic prescribing guidelines, the descriptive analysis revealed three antibiotic prescribing trends amongst the 21 clinicians: minimal (n = 10), moderate (n = 7), and excessive (n = 4). Individual best practice surfaced as the first major category and describes how each of the providers was attempting to do what he or she believed to be clinically best for the patient presenting with acute respiratory symptoms.; Perceived patient satisfaction emerged as the second major category and describes how the providers were attempting to satisfy patients or parents of patients, according to their own perceptions of the patient's potential to be satisfied. Balancing Acts emerged as the basic social process and is defined as a dynamic process where clinicians weigh individual best practice against perceived patient satisfaction. Evolving from Balancing Acts and its major categories, the Scale Model for Acute Respiratory Infection Treatment (SMART) was developed and visually portrays the antibiotic prescribing process, using the image of a scale. Results of this investigation hold important implications for patient and clinician education to reduce inappropriate antibiotic use for acute respiratory infections. |
