Abstract/Summary

ABSTRACT Objective: To 1) explore patients’ expectations and experiences of nurse and pharmacist non- medical prescriber led management of respiratory tract infections, 2) to examine whether patient expectations for antibiotics affect the likelihood of receiving them, and 3) to understand factors influencing patient satisfaction with respiratory tract infection consultations. Design: Mixed methods Setting: Primary care Participants: Questionnaires from 120 patients and follow-up interviews with 22 patients and 16 nurse and pharmacist non-medical prescribers. Results: Patients had multiple expectations of their consultation with 43% expecting to be prescribed an antibiotic. There was alignment between self-reported patient expectations and those perceived by non-medical prescribers. Patient expectations for non-antibiotic strategies, such as education to promote self-management, were associated with receipt of those strategies, whereas patient expectations for an antibiotic were not associated with receipt of these medications. ‘Patient-centred’ management strategies (including reassurance and providing information) were received by 86.7% of patients. Regardless of patients’ expectation or the management strategy employed, high levels of satisfaction were reported for all aspects of the consultation. Taking concerns seriously, conducting a physical examination, communicating the treatment plan, explaining treatment decisions, and lack of time restrictions, were each reported to contribute to patient satisfaction. Conclusion: Non-medical prescribers demonstrate an understanding of patient expectations of respiratory tract infection consultations and use a range of non-antibiotic management strategies, particularly those resembling a patient-centred approach. Overall, patients’ expectations were met and prescribers were not unduly influenced by patient expectations for an antibiotic. Patients were satisfied with the consultation, indicating that strategies used by non-medical prescribers were acceptable. However, the lower levels of satisfaction among patients who expected but did not receive an antibiotic, indicates that although NMPs appear to have strategies for managing RTI consultations, there is still scope for improvement and these prescribers are therefore an important group to involve in antimicrobial stewardship.