Table 2 Illustrative quotes:Characteristics of RTI’s visits and Expectations and adequacy of antibiotic treatment

Characteristics of RTI’s visits

The concept of RTI

It is one of the main reasons for the consultations we get, and they involve many hours and many visits to address the reasons for consultation, most of which are trivial, and wouldn’t require them to come, but they all come…here. (Professional(P)3, DAP-Trial participant, medium-high socioeconomic area)

(…) I mean apparently it does not seem to be a serious or very complicated disease most of the times, but in daily practice, it is quite demanding. (P13, DAP-Trial non-participant, medium-low socioeconomic area)

And then they say to you “oh, well, the virus again—when you don’t know what I’ve got, I’ve always got a virus”. That has been said to me. (P25, DAP-Trial non-participant, medium-high socioeconomic area)

RTI visits

Sometimes I don’t know, because they come so often with early symptoms, and one doesn’t know what’s going to happen after 24 hours, right? There are people who come, let’s say, in the ”prodromal stage” of the disease, right?, and you think “well, I don’t know”. (P2, DAP-Trial participant, medium-low socioeconomic are))

They are congested with an upper airway cold, but then “if it goes down to my chest”, things get very complicated. Well, I don’t know, sometimes they have a history of pneumonia or more serious problems, and then this… (P13, DAP-Trial non-participant, medium-low socioeconomic area)

Colds, as you say, and gastroenteritis, these used to be resolved at home, and now people go to the doctor. (P9, DAP-Trial participant, medium-high socioeconomic area)

Yes, I’d say we do secondary education, right?, and the potential complications. But at a primary prevention level, well, yes, more healthcare education should be conducted at the healthcare level as well as from mass media, other institutions, right?… I don’t know… in adult day care, at schools or… In order to improve self-care and knowing that with an — apparently unimportant— cold, people with no other illnesses or complications, they shouldn’t first go to the doctor or the healthcare centre. (P4, DAP-Trial participant, medium-low socioeconomic area)

… since they are going to solve it for me, I don’t need to try to be more self-sufficient. (P4, DAP-Trial participant, medium-low socioeconomic area)

Expectations and adequacy of antibiotic treatment

Physician-indicated treatment

In a patient with an uncomplicated acute infection, if this patient has no risk factors and is not very old, then a minimal examination, and depending on the symptoms, then the treatment… at most, a symptomatic treatment with paracetamol and a mucolytic if they have a lot of mucus; or if they have sneezing and congestion symptoms, an antihistamine, and so on… (P1, DAP-Trial participant, medium-high socioeconomic area)

Supposedly at least a viral presentation and the treatment…it should be with paracetamol. (P13, DAP-Trial non-participant, medium-low socioeconomic area)

Inappropriate antibiotic use

Also with regard to the clinicians, there may have been a bit of defensive medicine, right?, In order to play it safe, we prescribe antibiotics so they won’t come back, or to satisfy the patient, or, I don’t know, this has been going on for a long time too. (P14, DAP-Trial non-participant, medium-low socioeconomic area)

I believe that it is quite rational now, compared to 10 years ago. For instance, I believe that now we prescribe perhaps 10 times less antibiotics. In my opinion, I don’t know what the statistics say, but I think we prescribe antibiotics much less often now than 10 or 15 years ago. (P19, DAP-Trial non-participant, medium-low socioeconomic area)

(…) And then, we often visit this type of patient profile in the unscheduled visits where not even the same doctor visits them. So the credibility of the professional here counts for a lot. For me, it’s much easier to work with my usual patients than when I visit with someone else. (P23, DAP-Trial non-participant, medium-high socioeconomic area)

The mindset in England or Germany is not the same as here, where since I was a child I have had the feeling that they are used to taking antibiotics relatively often. It’s not their fault either, but also maybe there hasn’t been a good education. They come in a second time, this second visit you give it [the antibiotic] them so they won’t come back, I don’t know, sometimes we are all a little guilty. (P20, DAP-Trial non-participant, medium-high socioeconomic area)

Patient self-medication

Many times they say, “no, I’m already taking paracetamol, aren’t I?“, then, —“then continue, very well”— “but I’m not cured” —“wait… wait a few days, and you’ll see, right?“ (P23, DAP-Trial non-participant, medium-high socioeconomic area)

A minority [has already started antibiotic treatment]. Pills left over from the last time, or from their grandmother. (P11, DAP-Trial participant, medium-high socioeconomic area)