Balancing acts: deciding for or against antibiotics in acute respiratory infections

Overprescribing of antibiotics for acute respiratory infections (ARIs) has contributed to antibiotic resistance. Multiple clinician, patient, and system-related factors contribute to the prescribing of antibiotics for ARIs; however, these factors do not explain how clinicians arrive at their decisions to prescribe antibiotics. The purpose of our study was to describe this decision-making process. We conducted comprehensive interviews with 21 primary health care clinicians practicing in a rural Western US community. Our study used a qualitative descriptive design informed by grounded theory, and we analyzed data with a constant comparative method. Two theoretical concepts emerged from the interviews: 1) individual best practice described how each clinician attempted to do what he or she believed to be clinically best for the patient presenting with acute respiratory symptoms. The second concept, perceived patient satisfaction, described how the clinicians endeavored to satisfy patients, according to their own perceptions of the patient's potential to be satisfied. 2) Balancing acts emerged as the basic social process and is defined as the process whereby clinicians weigh individual best practice against perceived patient satisfaction when deciding whether to prescribe antibiotics for patients presenting with ARIs. The results of this investigation have important clinical and educational implications for reducing inappropriate antibiotic use for ARIs. Further controlled trials are warranted.