Antibiotic prescription in Swedish primary care consultations

The research project Antibiotic prescription in Swedish primary care consultations combines research in linguistics, sociology and medicine to investigate the interactional patterns of antibiotic prescription in Swedish primary care. We have collected video-recordings of clinical consulations at three primary care centers. Our analysis explores howantibiotic treatment discussions are carried out in situ within the details of medical consultations. The project also includes an applied component as we will translate our findings into teaching resources targetted towards pre- and post-qualification medical training and nursing programs. 

Data collection was completed in November, 2019. The research is organized in two sub projects: Klara Bertils’ doctoral thesis and a collection of studies that involves collaboration between PI Anna Lindström, Rebecca Barnes, John Heritage, and Thomas Tängdén.

Doctoral thesis project: Taking the temperature: Exploring the social dimensions of fever in acute respiratory tract infection patients

Measuring patients’ body temperature is routinely done in acute primary care, and patients’ history of fever may be taken into account when doctors consider a bacterial diagnosis. This monograph thesis will explore how fever and body temperature are discursively constructed by patients and health care professionals in clinical encounters in the UUIC: Primary Care corpus. Prior studies highlight testing and clinical measurements as activities in which health care professionals and patients expose, propose and negotiate epistemic and deontic positions (Kurhila & Lehtimaja, 2019; Pillet-Shore, 2006; Pomerantz & Rintel, 2004). Several features of body temperature suggest that temperature measurement is particularly interesting from an epistemic point of view. Patients can measure their own body temperature at home prior to the medical consultation, and may thus claim independent knowledge about their current body temperature, their history of fever and their individual normal temperature. Patients are also familiar with temperature readings, and may therefore act as capable to interpret, assess and even challenge measurement results. Furthermore, temperature is not only a set value, but also a body sensation: patients can feel a fever. Fever can thus be considered a phenomenon in which biometric and lifeworld perspectives coincide (Mishler, 1984), and in which patients may claim a strong epistemic authority. The study examines interaction about fever and body temperature throughout the consultations, aiming for a closer understanding of patient behavior and negotiation in a setting in which patient pressure and inappropriate antibiotic prescription are a concern.

Matteo Fusco // Unsplash

Collaborative Project: Cultures of Prescribing

The collaborative component of the project involves comparisons with comparable data corpora from the UK and the US. One of the first things that struck us was that near-patient tests (i.e. the C-reactive protein test and the Rapid Streptococcal Antigen Detection test) are more prevalent in the Swedish data than in the UK and US data. Our first paper will focus on how clinicians introduce the CRP-test to patients Swedish primary care. In particular we will explore how the clinician positions the test vis-à-vis information gained from patient problem presentation and physical examination. Preliminary findings suggests that the manner in which the test is introduced impacts antibiotic prescription. More broadly and in relation to the current Covid-19 context the CRP-study also sheds light on the complexities entailed in discussing tests and test results with patients who are presenting with symptoms of acute respiratory tract infection. Some of the other topics that we are jointly exploring include antibiotic treatment recommendations, self- care recommendations, patient practices for lobbying for antibiotics, and safety-netting.

Related presented research

  1. Barnes, Rebecca. “‘Safety-netting’ in acute paediatric medical visits: Recommending a contingent course of action”  Paper presented at The Symposium on Antibiotic Prescription in Primary Care: Comparative Perspectives, Uppsala University, Uppsala, Sweden, September 16–18 2019.
  2. Barnes, Rebecca. “Understanding Antibiotic Prescribing Patterns in Out-of-Hours Primary Care.”  Paper presented at The Symposium on Antibiotic Prescription in Primary Care: Comparative Perspectives, Uppsala University, Uppsala, Sweden, September 16–18 2019.
  3. Bertils, Klara. “Managing talk about patients' medical problem in Swedish assistant nurse–patient interaction.” Paper presented at 7th International Meeting on CA & Clinical Encounters, University of Bristol, Bristol, United Kingdom, July 8–9 2019.
  4. Bertils, Klara. “Taking the temperature: initial observations on temperature        measurement in acute primary care.” Paper presented at The Symposium on Antibiotic Prescription in Primary Care: Comparative Perspectives, Uppsala University, Uppsala, Sweden, September 16–18 2019.
  5. Heritage, John. Intervening with CA #2. Paper presented at The Symposium on Antibiotic Prescription in Primary Care: Comparative Perspectives, Uppsala University, Uppsala, Sweden, September 16–18 2019.
  6. Lindström, Anna. ”Behandlingsordinationer vid halsont: Ett språkvetenskapligt bidrag till forskning om ansvarsfull användning av antibiotika.” Inaugural lecture, Kungliga Humanistiska Vetenskapssamfundet, Uppsala University, Uppsala, Sweden, November 20 2018.
  7. Lindström, Anna. “Near-patient tests as grounds for recommending treatment in Swedish Primary Care.” Paper presented at The Symposium on Antibiotic Prescription in Primary Care: Comparative Perspectives, Uppsala University, Uppsala, Sweden, September 16–18 2019.
  8. Lindström, Anna. “Prescribing antibiotics in Swedish primary care consultations.” Paper presented at 7th International Meeting on CA & Clinical Encounters, University of Bristol, Bristol, United Kingdom, July 8–9 2019.