56 Chapter 3 Our framework has not been validated in this study, which is needed before it can be implemented. Another limitation was the lack of objective measure of the effect size due to the inclusion of qualitative studies. This makes it not possible to determine which determinants are more relevant. Conclusions The most important determinants of inappropriate antibiotic prescribing are comorbidity, diagnostic uncertainty, the GPs perception of a patient’s wish for antibiotics, an inability to effectively negotiate or explain appropriate use of antibiotics and a direct request for an antibiotic by a patient. Although our framework needs validation before it can be used. It may provide a viable starting point for designing, implementing and conducting interventions aimed at evidence-based reduction of antibiotic prescriptions in primary care.
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