BMJ 2003;326:138 ( 18 January )

Primary care

Why do general practitioners prescribe antibiotics for sore throat? Grounded theory interview study

Satinder Kumar, senior research fellow, ^a Paul Little, professor of health services research, ^a Nicky Britten, director. ^b

^a Department of Primary Medical Care, University of Southampton, Southampton SO17 3RT, ^b Concordance Unit, Department of Primary Care and General Practice, Guy's, King's, and St Thomas's, University of London, London SE11 6SP

Correspondence to: S Kumar skk{at}soton.ac.uk

Objectives: To understand why general practitioners prescribe antibiotics for some cases of sore throat and to explore the factors that influence their prescribing.
Design: Grounded theory interview study.
Setting: General practice.
Participants: 40 general practitioners: 25 in the maximum variety sample and 15 in the theoretical sample.
Results: General practitioners are uncertain which patients will benefit from antibiotics but prescribe for sicker patients and for patients from socioeconomically deprived backgrounds because of concerns about complications. They are also more likely to prescribe in pressured clinical contexts. Doctors are mostly comfortable with their prescribing decisions and are not prescribing to maintain the doctor-patient relationship.
Conclusions: General practitioners have reduced prescribing for sore throat in response to research and policy initiatives. Further interventions to reduce prescribing would need to improve identification of patients at risk of complications and be workable in busy clinical situations.

What is already known on this topic Prescribing of antibiotics for sore throat has fallen in the past 10 years General practitioners overestimate patients' expectations for antibiotics What this study adds General practitioners are uncertain who benefits most from antibiotics for sore throat and are particularly concerned about complications Maintaining the doctor-patient relationship was not the primary reason for prescribing antibiotics Doctors are mostly comfortable with their antibiotic prescribing for sore throat

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© 2003 BMJ Publishing Group Ltd
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