57 Determinants of inappropriate antibiotic prescription in primary care in developed countries with general practitioners as gatekeepers 3 Tables Table 1. Overview determinants with examples of potential effective interventions DETERMINANTS ASSOCIATED WITH INAPPROPRIATE ANTIBIOTIC PRESCRIBING EXAMPLES OF POTENTIAL EFFECTIVE INTERVENTIONS Culture of professional medicine Diagnostic uncertainty CRP POCT * (44-46, 53-57) No access to guidelines due to high cost Free access to guidelines (58) Access to guidelines during consult is time-consuming CDSS† (47, 58) Culture of healthcare consumption Request by patient Patient education‡ (45, 59-61) Mass media campaign§ (62) Delayed antibiotic prescription| (44, 63-65) Clinician attitudes and beliefs Career > 10 years Feedback on antibiotic prescribing (45, 65-68) Primary care considered not responsible for development of antibiotic resistance Habit Inability to effectively negotiate or explain antibiotic use CST# (53, 66, 69, 70) GPs’ judgement of more severe illness CRP POCT * (44-46, 53-57) Medical liability Physician education ** (45, 67, 70, 71) Delayed antibiotic prescription| (44, 63-65) Delayed antibiotic prescription| (44, 63-65) The patient-clinician interaction Preserving GP–patient relationships Delayed antibiotic prescription| (44, 63-65) Empathy for patients and risk perception about the seriousness of the illness. Physician education ** (45, 67, 70, 71) GPs’ perception of high patient expectation for antibiotic CST# (53, 66, 69, 70) Disease behaviour of the patient Patient education‡ (45, 59-61) Patient factors and experiences patient Patients expect an antibiotic prescription due to past experiences and have high expectations of antibiotics Received antibiotics in previous year Patient education‡ (45, 59-61) Presence of comorbidity / belongs to risk group Ongoing use of corticosteroids Presence of fever Duration of symptoms ≥ 7 days More signs of inflammation (fever, etc.) Severity of illness at first contact Physician education ** (45, 67, 70, 71) Legend: *CRP POCT: C-reactive protein Point of Care testing for patients with a respiratory tract infection divers between uncomplicated and complicated respiratory tract infections and reduces antibiotic prescriptions. †CDSS: clinical decision support system is integrated in an electronic medical system. It gives direct access to guidelines and supports clinical decision making
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