全部 标题 作者
关键词 摘要

OALib Journal期刊
ISSN: 2333-9721
费用:99美元

查看量下载量

相关文章

更多...
Antibiotics  2013 

“How Do You Feel about Antibiotics for This?” A Qualitative Study of Physician Attitudes towards a Context-Rich Communication Skills Method

DOI: 10.3390/antibiotics2030439

Keywords: qualitative study, communication training method, patient-centered, primary care, communication items, LRTI

Full-Text   Cite this paper   Add to My Lib

Abstract:

To explore experiences with and views of general practitioners (GPs) on a physician communication training method in primary care and its applicability and implementation in daily practice, we performed a semi-structured qualitative study of GPs’ experience of training in and implementing a communication skills training program for managing lower respiratory tract infection (LRTI) which included a seminar, simulated patient consultation together with providing and receiving feedback on ones own transcript, and a seminar in a structured approach to the LRTI consultation. Seventeen out of 20 eligible GPs who had participated in the IMPAC 3T trial and were allocated to receiving enhanced physician communication training for managing lower respiratory tract infection participated. GPs’ experiences with the physician communication training method and its specific components were positive. The method gave GPs additional tools for managing LRTI consultations and increased their sense of providing evidence-based management. During the study, GPs reported using almost all communication items covered in the training, but some GPs stated that the communication skills diluted over time, and that they continued to use a selected set of the skills. The general communication items were most regularly used. Implementation of the method in daily practice helped GPs to prescribe fewer antibiotics in LRTI with the only perceived disadvantage being time-pressure. This study suggests that GPs felt positive about the physician communication training method for enhanced management of LRTI in primary care. GPs continued to use some of the communication items, of which general communication items were the most common. Furthermore, GPs believed that implementation of the communication skills in daily practice helped them to prescribe fewer antibiotics. The context-rich communication method could have wider application in common conditions in primary care.

References

[1]  Stewart, M. Patient-Centered Medicine: Transforming the Clinical Method, 2nd ed. ed.; Radcliffe Medical: Abingdon, UK, 2003.
[2]  Rethans, J.J.; Norcini, J.J.; Baron Maldonado, M.; Blackmore, D.; Jolly, B.C.; LaDuca, T.; Lew, S.; Page, G.G.; Southgate, L.H. The relationship between competence and performance: Implications for assessing practice performance. Med. Educ. 2002, 36, 901–909, doi:10.1046/j.1365-2923.2002.01316.x.
[3]  Butler, C.C.; Kinnersley, P.; Prout, H.; Rollnick, S.; Edwards, A.; Elwyn, G. Antibiotics and shared decision-making in primary care. J. Antimicrob. Chemother. 2001, 48, 435–440, doi:10.1093/jac/48.3.435.
[4]  Butler, C.C.; Rollnick, S.; Pill, R.; Maggs Rapport, F.; Stott, N. Understanding the culture of prescribing: Qualitative study of general practitioners’and patients’perceptions of antibiotics for sore throats. Br. Med. J. 1998, 317, 637–642, doi:10.1136/bmj.317.7159.637.
[5]  Cals, J.W.; Scheppers, N.A.; Hopstaken, R.M.; Hood, K.; Dinant, G.J.; Goettsch, H.; Butler, C.C. Evidence based management of acute bronchitis; sustained competence of enhanced communication skills acquisition in general practice. Patient Educ. Couns. 2007, 68, 270–278, doi:10.1016/j.pec.2007.06.014.
[6]  Brookes-Howell, L.; Hood, K.; Cooper, L.; Coenen, S.; Little, P.; Verheij, T.; Godycki-Cwirko, M.; Melbye, H.; Krawczyk, J.; Borras-Santos, A.; et al. Clinical influences on antibiotic prescribing decisions for lower respiratory tract infection: A nine country qualitative study of variation in care. Br. Med. J. Open 2012, 2, e000795.
[7]  Brookes-Howell, L.; Hood, K.; Cooper, L.; Little, P.; Verheij, T.; Coenen, S.; Godycki-Cwirko, M.; Melbye, H.; Borras-Santos, A.; Worby, P.; et al. Understanding variation in primary medical care: A nine-country qualitative study of clinicians’accounts of the non-clinical factors that shape antibiotic prescribing decisions for lower respiratory tract infection. Br. Med. J. Open 2012, 2, e000796.
[8]  Rollnick, S.; Kinnersley, P.; Butler, C.C. Context-bound communication skills training: Development of a new method. Med. Educ. 2002, 36, 377–383, doi:10.1046/j.1365-2923.2002.01174.x.
[9]  Cals, J.W.; Butler, C.C.; Hopstaken, R.M.; Hood, K.; Dinant, G.J. Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: Cluster randomised trial. Br. Med. J. 2009, 338, b1374, doi:10.1136/bmj.b1374.
[10]  Cals, J.W.; de Bock, L.; Beckers, P.J.; Francis, N.A.; Hopstaken, R.M.; Hood, K.; de Bont, E.G.; Butler, C.C.; Dinant, G.J. Enhanced communication skills and C-reactive protein point-of-care testing for respiratory tract infection: 3.5-Year follow-up of a cluster randomized trial. Ann. Fam. Med. 2013, 11, 157–164, doi:10.1370/afm.1477.
[11]  Cals, J.W.; Hopstaken, R.M.; Butler, C.C.; Hood, K.; Severens, J.L.; Dinant, G.J. Improving management of patients with acute cough by C-reactive protein point of care testing and communication training (IMPAC3T): Study protocol of a cluster randomised controlled trial. BMC Fam. Pract. 2007, 8, e15, doi:10.1186/1471-2296-8-15.
[12]  Cals, J.W.; Chappin, F.H.; Hopstaken, R.M.; van Leeuwen, M.E.; Hood, K.; Butler, C.C.; Dinant, G.J. C-reactive protein point-of-care testing for lower respiratory tract infections: A qualitative evaluation of experiences by GPs. Fam. Pract. 2010, 27, 212–218, doi:10.1093/fampra/cmp088.
[13]  Green, J.; Thorogood, N. Qualitative Methods for Health Research; Sage Publications: London, UK, 2004.
[14]  Levinson, W.; Roter, D. The effects of two continuing medical education programs on communication skills of practicing primary care physicians. J. Gen. Intern. Med. 1993, 8, 318–324, doi:10.1007/BF02600146.
[15]  Aspegren, K. BEME Guide No.2: Teaching and learning communication skills in medicine—A review with quality grading of articles. Med. Teach. 1999, 21, 563–570, doi:10.1080/01421599978979.
[16]  Rollnick, S.; Butler, C.C.; McCambridge, J.; Kinnersley, P.; Elwyn, G.; Resnicow, K. Consultations about changing behaviour. Br. Med. J. 2005, 331, 961–963, doi:10.1136/bmj.331.7522.961.
[17]  Rollnick, S.; Mason, P.; Butler, C.C. Health Behavior Change: A Guide for Practitioners; Churchill Livingston: London, UK, 1999.
[18]  Butler, C.C.; Simpson, S.A.; Dunstan, F.; Rollnick, S.; Cohen, D.; Gillespie, D.; Evans, M.R.; Health, S.L.; Alam, M.F.; Bekkers, M.J.; et al. Effectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: Practice based randomised controlled trial. Br. Med. J. 2012, 344, d8173, doi:10.1136/bmj.d8173.
[19]  Francis, N.A.; Butler, C.C.; Hood, K.; Simpson, S.; Wood, F.; Nuttall, J. Effect of using an interactive booklet about childhood respiratory tract infections in primary care consultations on reconsulting and antibiotic prescribing: A cluster randomised controlled trial. Br. Med. J. 2009, 339, b2885, doi:10.1136/bmj.b2885.
[20]  Briel, M.; Langewitz, W.; Tschudi, P.; Young, J.; Hugenschmidt, C.; Bucher, H.C. Communication training and antibiotic use in acute respiratory tract infections. A cluster randomised controlled trial in general practice. Swiss Med. Wkly. 2006, 136, 241–247.
[21]  Britten, N. Qualitative interviews in medical research. Br. Med. J. 1995, 311, 251–253, doi:10.1136/bmj.311.6999.251.
[22]  Wood, F.; Phillips, C.; Brookes-Howell, L.; Hood, K.; Verheij, T.; Coenen, S.; Little, P.; Melbye, H.; Godycki-Cwirko, M.; Jakobsen, K.; et al. Primary care clinicians’ perceptions of antibiotic resistance: A multi-country qualitative interview study. J. Antimicrob. Chemother. 2013, 68, 237–243, doi:10.1093/jac/dks338.
[23]  Anthierens, S.; Tonkin-Crine, S.; Douglas, E.; Fernandez-Vandellos, P.; Krawczyk, J.; Llor, C.; Cals, J.W.; Francis, N.A.; Yardley, L.; Coenen, S.; et al. General practitioners’ views on the acceptability and applicability of a web-based intervention to reduce antibiotic prescribing for acute cough in multiple European countries: A qualitative study prior to a randomised trial. BMC Fam. Pract. 2012, 13, e101, doi:10.1186/1471-2296-13-101.

Full-Text

Contact Us

[email protected]

QQ:3279437679

WhatsApp +8615387084133