Antibiotic treatment failure when consulting patients with respiratory tract infections in general practice. A qualitative study to explore Danish general practitioners’ perspectives

Figures & data

Table 1. Interview guide.

Questions based on if the GP remembered a specific, relevant case

Questions on the topic in general (both in relation to the GPs’ own definition of ATF and when consulting patients with acute RTIs)

Do you remember a specific case of antibiotic treatment failure? If so: Please describe case in detail, here including your understanding of antibiotic treatment failure. Did you expect a possible treatment failure or did the treatment failure come unexpectedly? Any following complication or problems. The patient’s reaction. Did your image of yourself as a doctor change? Was the doctor–patient relationship (trust) affected? Additional comments on the case.

Do you consider antibiotic treatment failure a general problem in general practice (your own practice/generally)? Any common features of occurring cases. Acute respiratory tract infection vs other infections —does it differ? Which factors determine the need of an antibiotic prescription? In cases of doubt—prescribe or withhold? Why do you believe this topic (antibiotic treatment failure) is not more examined or discussed? Do you find that there is a need for increased focus, debate or research? Additional comments.

Box 1. Example of the process of analysis, turning meaning unit into codes.

MEANING UNIT		CODES
‘I don’t know how many treatment failures there are. I have my own clinical experience, and I don’t encounter many treatment failures there. I encounter perhaps more uncertain diagnoses, or that the treatment was initiated on a loose indication. And then I find that it is perhaps more diagnostic failure than treatment failure right?’	→	I. Overall treatment failure is not a great concern/is unimportant.
	→	II. Treatment failure is hard to define and ‘get a hold of’.

Table 2. Example of theme, category, subcategories and some belonging codes.

Theme	Antibiotic treatment
Category	Factors of influence
Sub-categories	Scientific influence	Influence due to patient characteristics	Influence due to patient demand	Influence due to other factors
Codes	Guidelines followed as far as possible Advice from colleagues/specialists The issue of bacterial resistance is essential The overall clinical impression of the patient is essential	Expectations of low patient compliance The patient’s general health condition (age, immunologically challenged, chronic illness)	Requests for children from their parents Requests due to weekends, holidays and other events Habits from patient’s former GP Expectations of simple and effective treatment	Time pressure Seasonal variation/epidemics Price Being tired when working/lacking energy to argue Experience changing GPs’ perspective gradually

Table 3. Baseline characteristics of participants.

GP	Gender	Years as GP
1	Male	0^a
2	Male	0^a
3	Female	1
4	Male	0^a
5	Female	1
6	Female	21
7	Male	35
8	Male	30
9	Male	32
10	Female	0^a
11	Female	12
12	Male	12
13	Male	20
14	Female	23
15	Male	9
16	Female	24
17	Male	20
18	Female	20

^a In specialist training.