Delayed prescriptions: Evolution of an innovation

Background Use of a delayed prescription (to be filled at a later time if the patient’s condition fails to improve or deteriorates) is a strategy to reduce prescribing of unnecessary antibiotics without damaging the doctor-patient relationship. Objectives To better understand general practitioners’ (GPs’) use of delayed prescriptions to reduce unnecessary antibiotic use and why their use of this innovation might change over time. Methods Qualitative study using semi-structured interviews conducted in family practice in Auckland, New Zealand. The sample was thirteen GPs previously reporting high or low use of delayed prescriptions for antibiotics. The outcome measures were their experiences of delayed antibiotic prescription use; reasons for using or not using delayed prescriptions; to which patients they would give them, and the specific instructions they give to patients. Results All GPs considered they had spontaneously developed the innovation of using delayed prescriptions. Their rationale was that limiting antibiotics would reduce side-effects, save patients money and reduce the appearance of resistant strains of bacteria. Confidence and frequency in using the strategy was assisted by knowing that other GPs used it and that its use was being researched. Some had decreased using delayed prescriptions after several years’ use because their patients were educated not to expect antibiotics for viral illnesses. The duration of the delay before using the antibiotic was variable, as was the age group of patients and the specific conditions under which they would use the innovation.