Acute cough: a qualitative analysis of how GPs manage the consultation when patients explicitly or implicitly expect antibiotic prescriptions
Acute cough: a qualitative analysis of how GPs manage the consultation when patients explicitly or implicitly expect antibiotic prescriptions
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DOI：
10.1093/fampra/cmh505
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发表时间：
2004-10-01
期刊：
影响因子：
2.2
通讯作者：
Wilm, S
中科院分区：
文献类型：
--
作者：
Altiner, A;Knauf, A;Wilm, S
客观的。本研究的目的是分析当患者明确或隐含地期望抗生素处方时，全科医生如何管理急性咳嗽的咨询。方法。对录音咨询进行了定性分析。参与者是来自德国北莱茵州 8 个全科诊所的 8 名全科医生以及 42 名在两周内出现急性咳嗽的患者。三位研究者独立分析咨询结果，最终经讨论达成一致的结果。经常发现对抗生素的隐含期望，但在 42 次咨询中，没有一次患者直接询问她或他对治疗的期望。期望和要求本身的话题通常根本不会被讨论，甚至不会以非直接的方式进行讨论。在一些咨询中，全科医生从一开始就排除了开抗生素处方的可能性。在一些咨询中，甚至发现了“伪同意”，避免了任何明确的澄清。全科医生似乎高估了为急性咳嗽开抗生素的实际压力。抗生素（过度）处方可能不是知识问题，而是缺乏以患者为中心的问题。
Objective. The aim of this study was to analyse how GPs manage the consultation for acute cough when patients explicitly or implicitly expect antibiotic prescriptions.Methods. A qualitative analysis of audio-taped consultations was carried out. The participants were eight GPs from eight general practices in Northrhine, Germany and their 42 patients with acute cough over a 2 week period. Three researchers analysed the consultations independently, finally agreed by discussion.Results. Implicit expectations for antibiotics were found frequently, but in none of the 42 consultations was the patient asked directly what she or he expected in terms of therapy. The topic of expectations and demands itself normally was not discussed at all, not even in a non-direct manner. In some consultations, the possibility of an antibiotic prescription was ruled out by the GP from the beginning. In some consultations, even a 'pseudo-consent' was found, avoiding any explicit clarification.Conclusion. GPs seem to overestimate the actual pressure to prescribe antibiotics for acute cough. The (over) prescription of antibiotics might not be a question of knowledge but a lack of patient centredness.