GPs’ Perspective on a Multimodal Intervention to Enhance Guideline-Adherence in Uncomplicated Urinary Tract Infections: A Qualitative Process Evaluation of the Multicentric RedAres Cluster-Randomised Controlled Trial
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Participant Selection
2.3. Setting
2.4. Data Collection
2.5. Research Team and Reflexivity
2.6. Data Analysis
2.7. Ethics
3. Results
3.1. Determinants of Decision Making
3.2. Perspectives on the RedAres Interventions
3.2.1. Information Material on Guideline Recommendations
3.2.2. Regional Resistance Data
3.2.3. Prescription Feedback
3.2.4. Benchmarking
3.2.5. Perception of the Intervention Format
3.3. Promoting Factors and Barriers for Implementation
4. Discussion
4.1. Potential Drivers for Implementation
4.2. Potential Barriers to Implementation
4.3. Including a Public Health Perspective in Clinical Decision Making
4.4. Strengths and Limitations
5. Conclusions
6. Recommendations
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
- General evaluation of the RedAres study
- Evaluation of content and usability
- Technical and organizational feasibility in the practice and for physician assistants
- Integration of physician assistants
- Determinants of decision-making
- Intervention materials
- Information material
- Evaluation of content and usability
- Evaluation of the format, suggestions for optimization
- RKI resistance data
- Evaluation of content and usability
- Evaluation of the format, suggestions for optimization
- Perspectives on implementation into regular practice
- Prescription feedback
- Evaluation of content and usability
- General evaluation
- Confirmation of prescription behavior, promoting treatment safety
- Gain in knowledge, refreshing contents
- Reflection and adaptation of prescribing behavior
- External experience with prescription feedback
- Evaluation of benchmarking
- General evaluation
- Confirmation of prescription behavior, promoting treatment safety
- Gain in knowledge, refreshing contents
- Reflection and adaptation of prescribing behavior
- External experience with prescription feedback
- Evaluation of the format, suggestions for optimization
- Perspectives on implementation into regular practice
- Attitude towards data protection
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Subcategory | Citation |
---|---|
Perceived competence | “Basically, I need a lot of routine and then I feel safe.” (10-by_int_63: 29) “Sometimes you feel insecure there […] confidence comes when you have evidence-based guidelines, where you can say, okay, this helps and I’m doing everything right.” (17-by_int_09: 28) |
Collegial exchange | “We are lucky enough to have such a round table of further education in our region. […] There’s a relatively large amount of exchange in collegial discussions, and […] questions like these [about antibiotic prescriptions] also come up in the round afterwards” (4-ber_int_25: 31) |
Time constraints | “If I treated all my patients according to the guidelines, they would be busy with medicine all day. So [...] you can read through it, that’s what we do, but I can’t really sign off on treating patients absolutely according to guidelines.” (5-bw_int_49: 21) |
Quality of information | “With some recommendations, one has nevertheless somewhat the hidden suspicion if there are industrial interests [...] behind it. One will then perhaps sometimes be a little more defensive.” (11-bw_int_60: 37) “You also get a lot of information that is almost too much [...], then you can get quite lost in all this stuff [...].” (15-th_int_34: 42) |
Category | Subcategory | Citation |
---|---|---|
Information material | Knowledge and confirmation | “Yes, it was a good refresher for me.” (15-th_int_34: 18) “some drugs like [...] Pivmecillinam were unknown to me.” (9-by_int_10: 35) |
Education and patient communication | “I also gave [the information material] to the training assistants and talked to them. And that was also good feedback for both of us.” (2-ber_int_05: 15) “Materials for patients are also important. Particularly when they are faced with unfamiliar therapeutic decisions [...] it is nice to have an argumentation paper with the stamp of the [university clinic] or a larger institution.” (2-ber_int_05: 25) | |
Regional resistance data | Knowledge and confirmation, breaking routines | “That was an eye-opener. [...] I was very grateful for this information, because I really wouldn’t have gone to the Robert Koch Institute website on my own.” (14-bw_int_57: 25) “What came from the Robert Koch Institute is also well in line with our practice”. (13-by_int_69: 51) “Especially with uncomplicated infections, you don’t think too much about what you prescribed, what you prescribed last time. [...]. But it’s interesting to have that presented to you and to see, oh, you took this (decision) once, which you actually didn’t want to take anymore.” (4-ber_int_25: 51) |
Relevance for practice | “Resistance avoidance is a relevant point [...] I just think that the regional resistance data do not influence every decision.” (16-bw_int_56: 38) “I think it’s more relevant in the stationary setting, because we often don’t have these decisions that require antibiotic stewardship [...] I think we must set other priorities” (16-bw_int_56: 34) | |
Prescription feedback | Knowledge and confirmation | “You think: Well, we’re doing everything right, and so on. But it’s nice to see it again in print and then finally quoted in some kind of diagram.” (2-ber_int_05: 65) “that’s what makes reflection possible in the first place [...] it [...] provides an opportunity for discussion and reflection.” (12-th_int_36: 65) |
Experiences and hurdles | “I prescribe [antibiotics] and say: [...] the urinary tract infection is so strong you have to take it now. [...] or they just get it as a backup for the next time.” (5-bw_int_49: 49–53) “We get feedback [from the Association of Statutory health insurance Physicians], not about the resistances and the right antibiotic, but about [economic] prescribing behaviour.” (17-by_int_09: 54) | |
Benchmarking | Knowledge and confirmation | “Actually, I think that’s quite good, because you actually compare yourself a bit. [...] So if I were completely off the mark, I would ask myself: What am I doing differently? (6-th_int_44: 73) “The comparison has somehow also shown that we have actually done quite well [...] encouraging me to continue in this way.” (19-by_int_65: 73) |
Experiences and hurdles | “And I think that’s problematic in part because you can’t compare the practices with each other”. (17-by_int_09: 54)“I don’t necessarily always have to compare myself with others.” (14-bw_int_57: 45) | |
Intervention format | Experiences and hurdles | “I need a clear recommendation from which I can derive a clear recommendation for the individual case. [...] I also don’t need a lot of justifications or [...] references to studies. Basically, I need a mini guideline that I can use.” (10-by_int_63: 29) |
Category | Subcategory | Citation |
---|---|---|
Promoting factors | Information streams | “So [with] local resistance situations [...] I would hope that it would be mirrored more often in the future via the laboratory.” (19-by_int_65: 61) |
Presentation of information | “Generally, I think that this feedback is very useful. Especially if [...] coupled with [...] information that is short and [...] that considers essential aspects of recent developments or guidelines.” (18-ber_int_19: 74) “You can do this anonymously and simply say: [...] we have observed in your region that it is like this and like that [...]. Now, if someone points the finger at a particular colleague and says: “You did this and that wrong”, then, of course, it’s not comfortable on a personal level.” (4-ber_int_25: 83) | |
Use of routine data | “So, more transparency and more [...] data collection. [...] We need the routine data, [...] how else are we really going to make serious scientific progress”. (18-ber_int_19: 98–100) “I mean, in the end you have to say that if you take the individual data into account, you can of course subdivide them a bit more precisely [...].” (3-by_int_66: 65) | |
Barriers | Comparability | Therefore, I find it relatively difficult to compare the practices with each other [...] So I wouldn’t draw any information from it if it said that I prescribed something completely different than all the other practices.” (4-ber_int_25: 65) |
Data misuse | So [the possibility to access the data] should really only be available to independent research institutions [...]. As soon as there are any possibilities that this could drift into pharmaceutical companies [...] then of course it is very problematic.” (12-th_int_36: 81) | |
Financial penalties | “We always get the information from the Association of Statutory Health Insurance Physicians about which drugs we prescribe too much. But there, it is always associated with severe penalties [...]. Of course, I don’t think that’s such a good thing.” (10-by_int_63: 75) | |
Conflict of interests | “If you always [...] list drugs that are not in discount contracts or that are not among the cheaper ones, then we get audit problems because we are required to meet certain targets for those in primary care.” (9-by_int_10: 17) |
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Schuster, A.; Tigges, P.; Grune, J.; Kraft, J.; Greser, A.; Gágyor, I.; Boehme, M.; Eckmanns, T.; Klingeberg, A.; Maun, A.; et al. GPs’ Perspective on a Multimodal Intervention to Enhance Guideline-Adherence in Uncomplicated Urinary Tract Infections: A Qualitative Process Evaluation of the Multicentric RedAres Cluster-Randomised Controlled Trial. Antibiotics 2023, 12, 1657. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics12121657
Schuster A, Tigges P, Grune J, Kraft J, Greser A, Gágyor I, Boehme M, Eckmanns T, Klingeberg A, Maun A, et al. GPs’ Perspective on a Multimodal Intervention to Enhance Guideline-Adherence in Uncomplicated Urinary Tract Infections: A Qualitative Process Evaluation of the Multicentric RedAres Cluster-Randomised Controlled Trial. Antibiotics. 2023; 12(12):1657. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics12121657
Chicago/Turabian StyleSchuster, Angela, Paula Tigges, Julianna Grune, Judith Kraft, Alexandra Greser, Ildikó Gágyor, Mandy Boehme, Tim Eckmanns, Anja Klingeberg, Andy Maun, and et al. 2023. "GPs’ Perspective on a Multimodal Intervention to Enhance Guideline-Adherence in Uncomplicated Urinary Tract Infections: A Qualitative Process Evaluation of the Multicentric RedAres Cluster-Randomised Controlled Trial" Antibiotics 12, no. 12: 1657. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics12121657