ArticleJournal of the American Geriatrics Society2024
Diagnostic uncertainty and decision-making in home-based primary care: A qualitative study of antibiotic prescribing.
Article in Journal of the American Geriatrics Society, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
8 citing papers in PubMed, 6 citations in OpenAlex.
- Contextual Determinants of Clinical Pharmacists' Contributions to Team-Based Antimicrobial Stewardship in Jordanian Hospitals: A Realist-Informed Qualitative Study.Antibiotics (Basel, Switzerland) · 2026Article
- Microbiology testing around the time of antibiotic initiation among residents of long-term care facilities.The Journal of antimicrobial chemotherapy · 2026Article
- Association of a Hospital-Wide Integrated Stewardship Intervention with Hospital-Acquired Multidrug-Resistant Organism Infection Incidence Density: A Large-Scale Interrupted Time-Series Study.Antibiotics (Basel, Switzerland) · 2026Article
- Physicians' understanding of antibiotic prescribing in Korean long-term care hospitals: a multicenter cross-sectional study.Journal of health, population, and nutrition · 2026Article
- Implementing Information Resources to Support Shared Decisions in Australian Primary Care: A Qualitative Perspective of an Antimicrobial Stewardship Strategy.Antibiotics (Basel, Switzerland) · 2026Article
- Clinical Reasoning Uncertainty in Veterinary Medical Encounters with a Clinical Example.Veterinary sciences · 2025Review
- Evaluating antibiotic prescriptions and standardized surveillance definitions among infections in home-based primary care.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- Contributions of Specialized Nurses to Medication Management for Older People in Home Care: A Mixed-Method Systematic Review.Risk management and healthcare policy · 2025Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundEvaluating infection in home-based primary care is challenging, and these challenges may impact antibiotic prescribing. A refined understanding of antibiotic decision-making in this setting can inform strategies to promote antibiotic stewardship. This study investigated antibiotic decision-making by exploring the perspectives of clinicians in home-based primary care.
methodsClinicians from the Department of Veterans Affairs Home-Based Primary Care Program were recruited. Semi-structured interviews were conducted from June 2022 through September 2022 using a discussion guide. Transcripts were analyzed using grounded theory. The constant comparative method was used to develop a coding structure and to identify themes.
resultsTheoretical saturation was reached after 22 clinicians (physicians, n = 7; physician assistants, n = 2, advanced practice registered nurses, n = 13) from 19 programs were interviewed. Mean age was 48.5 ± 9.3 years, 91% were female, and 59% had ≥6 years of experience in home-based primary care. Participants reported uncertainty about the diagnosis of infection due to the characteristics of homebound patients (atypical presentations of disease, presence of multiple chronic conditions, presence of cognitive impairment) and the challenges of delivering medical care in the home (limited access to diagnostic testing, suboptimal quality of microbiological specimens, barriers to establishing remote access to the electronic health record). When faced with diagnostic uncertainty about infection, participants described many factors that influenced the decision to prescribe antibiotics, including those that promoted prescribing (desire to avoid hospitalization, pressure from caregivers, unreliable plans for follow-up) and those that inhibited prescribing (perceptions of antibiotic-associated harms, willingness to trial non-pharmacological interventions first, presence of caregivers who were trusted by clinicians to monitor symptoms).
conclusionsClinicians face the difficult task of balancing diagnostic uncertainty with many competing considerations during the treatment of infection in home-based primary care. Recognizing these issues provides insight into strategies to promote antibiotic stewardship in home care settings.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.