Table II.
Meaning units, categories, and themes.
| Meaning unit | Category | Theme |
| GPs adherent to guidelines (Quotation A): B: “We discuss in our team how to handle these patients. According to what evidence shows we share the same view of how these patients should be handled. The phone counselling nurse, nurses at the surgery and us doctors.” A: “Is that the key thing, that you have been talking so much?” B: “Yes, I think so.” (Interview 10) |
Knowledge shared within the team | Guideline knowledge |
| GPs non-adherent to guidelines (Quotation B): “I know pretty well when antibiotics treatment is right and when it's not. We got rid of routines, because we have RADT for all patients before the GP consultation.” A:” What do phone counselling nurses say? Have you discussed this issue?” B: “Nurses use [advice support] a lot of symptoms, advice, and measures but we have not discussed it.” (Interview 9) |
Idiosyncratic knowledge attitudes | |
| GPs adherent to guidelines (Quotation C): A: “When I talk to other doctors, they sometimes are afraid it could be something else. You don't think like that?” B: “No I don't. It could be both a streptococcus infection and mononucleosis, but then they won't get well, they will return and then you'll check for mononucleosis.” (Interview 19) “We need to make it less dramatic, we are treating symptoms and not because it's dangerous to have streptococci.” (Interview 17) |
No concern for bacterial infection and differential diagnoses | Preconceptions of bacterial infections and concerns for differential diagnosis |
| GPs non-adherent to guidelines (Quotation D): “Of course it could be a different throat disease, which is masked by tonsillitis. It could be cancer, however, only in very rare cases.” “We often do not find streptococci, but we must treat the patients anyway if we suspect it's bacterial.” (Interview 11) |
Concern for differential diagnoses and bacterial infection | |
| GPs adherent to guidelines (Quotation E): “If they have had a fever for at least three days and absence of a cold and cough then I would always prescribe a RADT.” (Interview 17) |
Targeted patient history and examination | Patient history and examination |
| GPs non-adherent to guidelines (Quotation F): “I would examine the patient's ears, nose, throat, neck lymph glands and I often listen to the lungs as well.” (Interview 2) “Sometimes it's a bacterial smell that you can feel during the visit. Then it happens that I just send in the prescription (for a broad spectrum antibiotic), as I know that penicillin V doesn't help, it smells too bad.” (Interview 14) |
Redundant and idiosyncratic patient history and examination | |
| GPs adherent to guidelines (Quotation G): “I'll discuss immediately with the patient. We'll try to reach a joint viewpoint on how sick they are.” (Interview 1) |
No problem to abstain from prescribing antibiotics | Compliance to abstaining from prescribing antibiotics |
| GPs non-adherent to guidelines (Quotation H): “It may lead to long discussions with patients who feel very sick, so it might be difficult. It takes time and you may still end up with a patient being unhappy with the management.” (Interview 6) |
Problems to abstain from prescribing antibiotics |
Note: A = interviewer, B = respondent GPs.