Cope Anwen L, Wood Fiona, Francis Nick A, Chestnutt Ivor G
Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK.
Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK.
BMJ Open. 2015 Oct 1;5(10):e008551. doi: 10.1136/bmjopen-2015-008551.
This study aimed to produce an account of the attitudes of general practitioners (GPs) towards the management of dental conditions in general practice, and sought to explore how GPs use antibiotics in the treatment of dental problems.
Qualitative study employing semistructured telephone interviews and thematic analysis.
17 purposively sampled GPs working in Wales, of which 9 were male. The median number of years since graduation was 21. Maximum variation sampling techniques were used to ensure participants represented different Rural-Urban localities, worked in communities with varying levels of deprivation, and had differing lengths of practising career.
Most GPs reported regularly managing dental problems, with more socioeconomically deprived patients being particularly prone to consult. Participants recognised that dental problems are not optimally managed in general practice, but had sympathy with patients experiencing dental pain who reported difficulty obtaining an emergency dental consultation. Many GPs considered antibiotics an acceptable first-line treatment for acute dental problems and reported that patients often attended expecting to receive antibiotics. GPs who reported that their usual practice was to prescribe antibiotics were more likely to prioritise patients' immediate needs, whereas clinicians who reported rarely prescribing often did so to encourage patients to consult a dental professional.
The presentation of patients with dental problems presents challenges to GPs who report concerns about their ability to manage such conditions. Despite this, many reported frequently prescribing antibiotics for patients with dental conditions. This may contribute to both patient morbidity and the emergence of antimicrobial resistance. This research has identified the need for quantitative data on general practice consultations for dental problems and qualitative research exploring patient perspectives on reasons for consulting. The findings of these studies will inform the design of an intervention to support patients in accessing appropriate care when experiencing dental problems.
本研究旨在阐述全科医生（GPs）对全科医疗中牙齿疾病管理的态度，并探讨全科医生在治疗牙齿问题时如何使用抗生素。
采用半结构化电话访谈和主题分析的定性研究。
17名在威尔士工作的全科医生，通过目的抽样选取，其中9名男性。毕业以来的中位年数为21年。采用最大变异抽样技术以确保参与者代表不同的城乡地区，在不同贫困程度的社区工作，且执业年限不同。
大多数全科医生报告称经常处理牙齿问题，社会经济地位较低的患者尤其容易前来咨询。参与者认识到牙齿问题在全科医疗中未得到最佳管理，但对那些报告难以获得紧急牙科咨询且牙齿疼痛的患者表示同情。许多全科医生认为抗生素是急性牙齿问题可接受的一线治疗方法，并报告称患者前来就诊时通常期望得到抗生素治疗。报告其惯常做法是开具抗生素的全科医生更倾向于优先满足患者的即时需求，而报告很少开具抗生素的临床医生这样做往往是为了鼓励患者咨询牙科专业人员。
牙齿问题患者的就诊给全科医生带来了挑战，他们对自己处理此类病症的能力表示担忧。尽管如此，许多人报告经常为牙齿疾病患者开具抗生素。这可能导致患者发病，并促使抗菌药物耐药性的出现。本研究确定需要有关牙齿问题全科医疗咨询的定量数据，以及探索患者咨询原因的定性研究。这些研究的结果将为设计一项干预措施提供信息，以支持患者在遇到牙齿问题时获得适当的护理。
