Communication training for general practitioners aimed at improving antibiotic prescribing:A controlled before-after study in multicultural Dutch cities

Introduction: Suboptimal doctor-patient communication drives inappropriate prescribing of antibiotics. We evaluated a communication intervention for general practitioners (GPs) in multicultural Dutch cities to improve antibiotic prescribing for respiratory tract infections (RTI).Methods: This was a non-randomized controlled before-after study. The study period was pre-intervention November 2019 – April 2020 and post-intervention November 2021 – April 2022. The intervention consisted of a live training (organized between September and November 2021), an E-learning, and patient material on antibiotics and antibiotic resistance in multiple languages. The primary outcome was the absolute number of prescribed antibiotic courses indicated for RTIs per GP; the secondary outcome was all prescribed antibiotics per GP. We compared the post-intervention differences in the mean number of prescribed antibiotics between the intervention (N = 25) and the control group (N = 110) by using an analysis of covariance (ANCOVA) test, while adjusting for the pre-intervention number of prescribed antibiotics. Additionally, intervention GPs rated the training and their knowledge and skills before the intervention and 3 months thereafter.Results: There was no statistically significant difference in the mean number of prescribed antibiotics for RTI between the intervention and the control group, nor for mean number of overall prescribed antibiotics. The intervention GPs rated the usefulness of the training for daily practice a 7.3 (on a scale from 1–10) and there was a statistically significant difference between pre- and post-intervention on four out of nine items related to knowledge and skills.Discussion:There was no change in GPs prescription behavior between the intervention and control group. However, GPs found the intervention useful and showed some improvement on self-rated knowledge and communication skills

Communication training for general practitioners aimed at improving antibiotic prescribing:A controlled before-after study in multicultural Dutch cities

Introduction: Suboptimal doctor-patient communication drives inappropriate prescribing of antibiotics. We evaluated a communication intervention for general practitioners (GPs) in multicultural Dutch cities to improve antibiotic prescribing for respiratory tract infections (RTI).Methods: This was a non-randomized controlled before-after study. The study period was pre-intervention November 2019 – April 2020 and post-intervention November 2021 – April 2022. The intervention consisted of a live training (organized between September and November 2021), an E-learning, and patient material on antibiotics and antibiotic resistance in multiple languages. The primary outcome was the absolute number of prescribed antibiotic courses indicated for RTIs per GP; the secondary outcome was all prescribed antibiotics per GP. We compared the post-intervention differences in the mean number of prescribed antibiotics between the intervention (N = 25) and the control group (N = 110) by using an analysis of covariance (ANCOVA) test, while adjusting for the pre-intervention number of prescribed antibiotics. Additionally, intervention GPs rated the training and their knowledge and skills before the intervention and 3 months thereafter.Results: There was no statistically significant difference in the mean number of prescribed antibiotics for RTI between the intervention and the control group, nor for mean number of overall prescribed antibiotics. The intervention GPs rated the usefulness of the training for daily practice a 7.3 (on a scale from 1–10) and there was a statistically significant difference between pre- and post-intervention on four out of nine items related to knowledge and skills.Discussion:There was no change in GPs prescription behavior between the intervention and control group. However, GPs found the intervention useful and showed some improvement on self-rated knowledge and communication skills

Mexicaanse griep: Risicoperceptie bij de bevolking, eigen maatregelen en vertrouwen in overheidsinformatie

Doel Inzicht krijgen in hoe Nederlanders het risico op de Mexicaanse griep inschatten tijdens het verloop van de afgelopen pandemie, hoeveel en welke mensen preventieve maatregelen namen en in hoeverre men ver trouwen had in de overheidsinformatie. Opzet Online-vragenlijstonderzoek, zowel dwarsdoorsnede- (eerste 2 metingen) als follow-uponderzoek (laatste 2 metingen). Methode In de periode 10-17 november 2009 vulden 754 personen een online-vragenlijst in. Eerdere metingen werden gehouden in mei (n = 572), juni (n = 620) en augustus 2009 (n = 934). Resultaten In november 2009 werd de Mexicaanse griep door 38% van de respondenten als een ernstige ziekte beschouwd en 36% achtte zichzelf vatbaar voor deze griep. Gevoelens van bezorgdheid waren afgenomen vergeleken met eerdere metingen. Van de respondenten had 73% maatregelen genomen om ziekte te voorkomen. Dit betrof met name hygiënemaatregelen, die het meest werden genomen door mensen die angstig waren, die hygiënemaatregelen ef fec tief vonden, die veel aandacht hadden besteed aan media informatie over de griep, die overheidsinformatie betrouwbaar vonden en die geen thuiswonende kinderen hadden. Ruim de helf t (58%) was van plan zich te laten vaccineren als zij daar voor in aanmerking zouden komen. Van de overige 315 respondenten gaf 40% aan bang te zijn voor ernstige bijwerkingen, 35% twijfelde over de ef fec tiviteit van het vaccin en 33% vond het vaccin niet goed getest. Bijna de helf t van de respondenten had de huis-aan-huisbrochure ‘Grip op griep’ gelezen en een derde had de televisiespotjes gezien. Landelijke overheidsinstanties, zoals het Ministerie van VWS en het RIVM, waren de belangrijkste bron van informatie en werden door ruim de helf t betrouwbaar gevonden. Conclusie Gedurende het verloop van de inf luenza A(H1N1)-pandemie in 2009 nam de bezorgdheid steeds verder af bij het Nederlandse publiek, terwijl men zich steeds vatbaarder achtte voor de griep. Men had dus een reëel beeld van de situatie. Drie kwar t van het publiek had maatregelen genomen om griep te voorkomen. Ruim de helf t was bereid zich te laten vaccineren als zij daar voor in aanmerking zouden komen. De belangrijkste reden om geen vaccinatie te willen was angst voor ernstige bijwerkingen en twijfels over de effectiviteit van het vaccin. Dit punt verdient aandacht bij de ontwikkeling van toekomstige voorlichtingscampagnes over vaccinaties

Providing antibiotics to immigrants: a qualitative study of general practitioners’ and pharmacists’ experiences

Background: If healthcare professionals perceive that patients strongly expect to be prescribed antibiotics, inappropriate prescriptions may result. As it is unknown whether this happens more often with certain patient groups, we explored whether general practitioners (GPs) and pharmacists perceived such expectations when they provided antibiotics to immigrant patients. Methods: Ten GPs and five pharmacists from Rotterdam, the Netherlands, were interviewed on the basis of a semi-structured topic guide. Atlas.ti software was then used to conduct a thematic analysis. Results: GPs felt that immigrant patients, especially those who had arrived recently, were more likely to expect to receive antibiotics than native Dutch patients. However, these expectations had decreased over the last years and did not always lead immigrants to exert pressure on them. Except for language barriers, the factors reported by GPs to influence their antibiotic prescribing behaviour were unrelated to patients’ immigrant background. If there was a language barrier, GPs experienced greater diagnostic uncertainty and needed additional time to obtain and communicate correct information. To overcome language barriers, they often used point-of-care testing to convince patients that antibiotics were unnecessary. Although pharmacists rarely experienced problems dispensing antibiotics to immigrants, they and GPs both struggled to find effective ways of overcoming language barriers, and stressed the need for multi-language support materials. Conclusion: While pharmacists rarely experience any problems providing antibiotics to immigrants, GPs regularly face language barriers with immigrant patients, which complicate the diagnostic process and communicating information in the limited available time. This sometimes leads antibiotics to be prescribed inappropriately

Separation of spouses due to travel and living apart raises HIV risk in Tanzanian couples.

BACKGROUND: Persons with absent partners may be more vulnerable to risky sexual behavior and therefore HIV. Partner absence can be due to traveling (e.g., family visits or funerals) or to living apart (e.g., work-related or in polygamous marriages). We investigated to what extent partner absence leads to more risky sexual behavior in Tanzanian couples. METHODS: We compared 95 men and 85 women living apart with 283 men and 331 women living together. Only persons who were still married were included, either living apart or cohabiting at the time of the interview. Subjects were classified into 4 groups: coresidents being either nonmobile or mobile, and people living apart either frequently or infrequently seeing each other. RESULTS: Most people living apart were polygamously married. Men living apart did not report more extramarital sex than coresident men. However, among coresident men, extramarital sex was reported by 35% of those being mobile compared with 15% of those nonmobile. Among women, those living apart reported extramarital sex more often than coresidents (14% vs. 7%), and this was mainly due to women living apart who infrequently saw their husbands. CONCLUSIONS: Risky sexual behavior occurs more often in mobile coresident men, and in women living apart infrequently seeing their spouses. These groups are relatively easy to identify and need extra attention in HIV prevention campaigns