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JAC Advance Access published online on November 16, 2006
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkl467
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Received June 27, 2006
Revised October 10, 2006
Accepted October 20, 2006

Original article

General practitioners' perceptions of antimicrobial resistance: a qualitative study

Sharon A. Simpson 1 *, Fiona Wood 1, and Christopher C. Butler 1

1 Department of General Practice, Cardiff University, 3rd Floor Neuadd Merionnydd, Heath Park, Cardiff CF14 4XN, UK

* To whom correspondence should be addressed.
Sharon A. Simpson, E-mail: simpsonsa{at}cf.ac.uk


  Abstract

Objectives: Interventions aimed at enhancing the quality of antibiotic prescribing often highlight the threat of antimicrobial resistance. Although most antibiotics are prescribed by general practitioners (GPs), little is known of their perceptions of this issue. The aim of this study was therefore to achieve a deeper understanding of GPs' perceptions of antimicrobial resistance.

Methods: A qualitative interview, grounded theory study. Forty GPs were interviewed, 26 from high fluoroquinolone prescribing practices and 14 from average fluoroquinolone prescribing practices.

Results: Most GPs were concerned about the broad issue of antimicrobial resistance and agreed that it was a growing problem. However, many said they infrequently encountered its consequences in their everyday practice and some questioned the evidence linking their prescribing decisions to resistance and poorer outcomes for their patients. They felt conflicted by their apparent inability to influence the problem in the face of many other competing demands. A number said they would welcome more information from their microbiological colleagues about resistance patterns locally, and felt that undergraduate and graduate education about antimicrobial prescribing and resistance should be enhanced. However, a few mentioned that a heightened awareness of antimicrobial resistance locally may cause them to prescribe more second line agents as empirical therapy.

Conclusions: Antimicrobial resistance is only one of a range of important influences on GPs decisions whether or not to prescribe an antibiotic and is not the most immediate. These influences all need to be taken into account when promoting a more cautious use of antibiotics in primary care. More information from microbiologist colleagues about local resistance would be clinically useful, but on its own, may paradoxically influence some GPs to prescribe newer, broader spectrum agents more often.

Keywords: grounded theory; primary care; decision making.
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