How can using this approach help you?
Prescribers already have good general communication skills and have their own individual approaches. However, given short consultations, it is easy to miss out an important element of a consultation or rush over an explanation. This can have a big impact on whether patients are happy with a prescribing decision.
Tweaking your discussions with patients can help:
- Increase patient satisfaction: Patients report high levels of satisfaction and enablement in managing their infection, and are more informed about the appropriate use and harms of antibiotics when prescribers discuss antibiotics effectively and when they discuss leaflets interactively.
- Reduce consultations: Prudent antibiotic prescribing with effective discussions about antibitoics help reduce re-consultations and future consultations. So it is worth investing a bit of time in these consultations in order to get future benefits.
- Reduce your antibiotic prescribing: The examples of how you may tweak your discussions with patients presented here have been shown to be effective in reducing antibiotic prescribing when trialled with prescribers in UK general practice.
This approach and the examples provided focus on things to say to patients with acute infections but you may also find them helpful for other consultations.
Evidence of benefits
Evidence shows that prescribers often overestimate patients' expectations for antibiotics and that patients' satisfaction is related to:
- Having a careful and thorough examination.
- Having their concerns identified and addressed.
- Having advice on how to manage their symptoms.
The examples and the CHESTSSS acronym provided on this website are based on enhanced communication skills training that has been shown to be effective in a trial [1] with experienced GPs in the UK and on the STAR training also shown effective in a UK-based trial [17]. Evidence from a recent systematic review [18] and a Cochrane overview of reviews [19] also found support for the use of communication skills training and shared decision making as effective strategies to optimise antibiotic prescribing in primary care.
Common questions and concerns
Some prescribers have questions and concerns about using this approach, for example:
- "I already use communication skills so what does this website add?"
Other prescribers have found it helpful to have examples of phrases to use and patients respond positively to these phrases. In particular, prescribers value the "timeline" examples, e.g. discussing and understanding how long infections normally last, and "shortcomings", e.g. explaining that antibiotics will not shorten the duration by much or help with pain. Sometimes patients may misinterpret what prescribers say (e.g. telling a patient that they have a viral infection may not reassure them and may make them feel 'fobbed off') - so finding the right words is important.
- "There isn't enough time in consultations."
The examples provided as part of CHESTSSS are short sentences that can be easily and quickly incorporated into what you already do and say in consultations.
- "How will this help with 'difficult' patients?"
Going through the elements of effective consultations (CHESTSSS) can be especially helpful with patients who are particularly concerned about their illness or expect/demand antibiotics. For example, providing non-serious explanations for symptoms, explaining how long infections normally last, and explaining shortcomings of antibiotics can help address patient concerns and reassure them.
- "My patients have limited English language skills."
Patient leaflets in many different languages and pictorial format are available on the TARGET toolkit website and are helpful in these situations.
