Prescription of antibiotics in primary care: Enhancing communication between general practitioners and immigrant patients

This thesis aimed to gain a better understanding of the (in)appropriate use of antibiotics by different population groups and the inappropriate prescribing of antibiotics by GPs, with a specific focus on prescribing antibiotics for immigrant patients. Furthermore, this thesis intended to evaluate a communication training for GPs that we developed and implemented based on the found insights into existing attitudes and practices. The intervention aimed to reduce the inappropriate prescribing of antibiotics, with the implicit assumption that it will help control antibiotic resistance.

Based on this thesis we formulated the following conclusions:
-Self-medication with antibiotics is practiced by a broad range of individuals and is explained by various determinants at the patient, healthcare professional, and healthcare system level.
-The main challenges of GPs and pharmacists when providing antibiotics to immigrants are related to language barriers, time limits, and a lack of multilingual information materials.
-GPs and pharmacists take initiative in overcoming language barriers but their methods can be improved for better results.
-In addition to the impact of a language barrier on the diagnostic process,
multiple universal factors that are unrelated to immigrant background explain
inappropriate prescribing of antibiotics.
- Immigrant patients can experience more problems during consultation with
their GP because of a language barrier, but, besides that, they experience
similar barriers and facilitators in the use of antibiotics and communication
with their GP as native Dutch patients.
- Communication training is effective in improving GPs knowledge and skills,
but not in reducing inappropriate antibiotic prescription.
- Teaching GPs effective communication skills remains vital as (perceived)
pressure from patients continues to influence antibiotic prescription.
- Considering the severity of AMR, healthcare in general and antibiotic
prescription in particular should be better tailored to the needs of immigrant
patients.