How can using this approach help you?
Prescribers already have good general communication skills and have their own individual approaches. However, given short consultations, it is easy to miss out an important element of a consultation. This can have a big impact on whether your
patients are happy with a prescribing decision.
Tweaking your discussions with patients can help:
- Increase patient satisfaction: Patients report high levels of satisfaction and enablement in managing their infection, and are more informed about the appropriate use and harms of antibiotics when you discuss antibiotics effectively
and when they discuss leaflets interactively.
- Reduce consultations: Prudent antibiotic prescribing with effective discussions about antibiotics help reduce re-consultations and future consultations. So it is worth investing a bit of time in these consultations.
- Reduce your antibiotic prescribing: The examples of how you may tweak your discussions with patients presented in the ‘Discussing Antibiotics with Patients’ website section have been shown to be effective in reducing antibiotic prescribing
when trialled with prescribers in UK general practice.
This approach and the examples provided focus on discussions with patients with acute infections but you may find them helpful for other consultations.
Evidence of benefits
Evidence shows that prescribers often overestimate patients' expectations for antibiotics and that patients' satisfaction is related to:
- Having a careful and thorough examination.
- Having their concerns identified and addressed.
- Having advice on how to manage their symptoms.
The examples and techniques presented in the ‘Discussing Antibiotics with Patients’ website section are based on enhanced communication skills training that has been shown to be effective in a trial with experienced GPs in the UK and on the STAR training also shown effective in a UK-based trial. The CHESTTS acronym was also developed and tested in this trial; however, it was
modified to CHESTSSS afterwards, where the T was split into two Ss – shortcomings and self-care.
Evidence from a systematic review and a Cochrane overview of reviews also found support for the use of communication skills training and shared decision making as effective strategies to optimise antibiotic prescribing in primary
care.
Common questions and concerns
Some prescribers may have questions and concerns about using this approach, for example:
"I already use communication skills so what do these resources add?"
Other prescribers have found it helpful to have examples of phrases to use and patients respond positively to these phrases. In particular, prescribers value the "timeline" examples, e.g. discussing and understanding how long infections normally
last, and antibiotic "shortcomings", and "shortcomings", e.g. explaining that antibiotics will not shorten the duration by much or help with pain. Sometimes patients may misinterpret what prescribers say (e.g. telling a patient that they have
a viral infection may not reassure them and may make them feel 'fobbed off') - so finding the right words is important.
"There isn't enough time in consultations."
The examples are short sentences that can be easily and quickly incorporated into what you already do in consultations.
"How will this help with 'challenging' patients?"
Going through the elements of effective consultations can be especially helpful with patients who are particularly concerned about their illness or expect/demand antibiotics. For example, providing non-serious explanations for symptoms, explaining
how long infections normally last, explaining shortcomings of antibiotics and the benefits of back-up/delayed antibiotic prescriptions can help address patient concerns and reassure them.
My patients have limited English language skills."
TARGET patient leaflets are helpful in these situations and are available here in many different languages and pictorial format.
