Quality statement 1: Advice on self-limiting conditions

Quality statement

People with a self-limiting condition, as assessed by a primary care prescriber, receive advice about self‑management and adverse consequences of overusing antimicrobials.

Rationale

People with common colds, sore throat, flu, otitis media and other self‑limiting conditions may not know that they are likely to get better without treatment and they may expect to be prescribed an antimicrobial. Primary care prescribers should manage people's expectations by describing the adverse consequences of using antimicrobials when they are not needed, both for the person and the population as a whole. They should also give advice on what the person can do to help their condition improve (self‑management).

Quality measures

Structure

a) Evidence of local arrangements to ensure that people with a self‑limiting condition, as assessed by a primary care prescriber, receive advice about self-management and adverse consequences of overusing antimicrobials.

Data source: Local data collection.

b) Evidence of local arrangements to promote self-management of self‑limiting conditions and raise awareness of risks associated with overusing antimicrobials.

Data source: Local data collection.

Process

a) Proportion of presentations in primary care assessed as a self‑limiting condition with a record stating that advice about self‑management was given.

Numerator – the number in the denominator with a record stating that advice about self‑management was given.

Denominator – the number of presentations in primary care assessed as a self‑limiting condition.

Data source: Local data collection and TARGET Antibiotics toolkit.

b) Proportion of presentations in primary care assessed as a self‑limiting condition with a record stating that advice about the adverse consequences of overusing antimicrobials was given.

Numerator – the number in the denominator with a record stating that advice about the adverse consequences of overusing antimicrobials was given.

Denominator – the number of presentations in primary care assessed as a self‑limiting condition.

Data source: Local data collection.

Outcome

Antimicrobial prescribing rates in primary care.

Data source: Local data collection.

What the quality statement means for service providers, prescribers and commissioners

Service providers (such as GP practices, health centres, pharmacies, community services) ensure that systems are in place for people with a self‑limiting condition to receive advice about self‑management and the adverse consequences of overusing antimicrobials.

Prescribers in primary care (such as GPs, nurses and pharmacists) ensure that they provide people with a self‑limiting condition with advice on self‑management and the adverse consequences of overusing antimicrobials.

Commissioners (clinical commissioning groups, NHS England) ensure that they commission services that provide people with a self‑limiting condition with advice on self‑management and the adverse consequences of overusing antimicrobials.

What the quality statement means for patients, people using services and carers

People with a condition that is likely to get better on its own (such as cold, flu, earache or tonsillitis) who go to a GP, practice nurse or pharmacist are given advice on what they can do to help their condition improve and why it's important only to use antimicrobials when they are really needed.

Source guidance

Definitions of terms used in this quality statement

Self-limiting condition

A self-limiting condition is likely to resolve without antimicrobial treatment. Self‑limiting conditions include acute otitis media, acute cough, acute bronchitis, acute sore throat, acute pharyngitis, acute tonsillitis, acute rhinosinusitis and the common cold.

[Respiratory tract infections (self-limiting): prescribing antibiotics (2008) NICE guideline CG69 (full guideline) and expert opinion]

Advice for people with self-limiting conditions

Prescribers should discuss with the person and/or their family members or carers (as appropriate):

  • the likely nature of the condition

  • why prescribing an antimicrobial may not be the best option

  • alternative options to prescribing an antimicrobial

  • their views on antimicrobials, taking into account their priorities or concerns about their current illness and whether they want or expect an antimicrobial

  • the benefits and harms of immediate antimicrobial prescribing

  • how long they should expect the symptoms of their self‑limiting condition to last

  • what they should do if their condition gets worse (safety netting advice) or if they have problems as a result of treatment

  • what they can do to minimise spreading the infection to others (such as good hand hygiene).

[Antimicrobial stewardship (2015) NICE guideline NG15, recommendation 1.1.31 and expert opinion]

Equality and diversity considerations

Healthcare professionals may need to consider how to advise people who have difficulties understanding the information given to them because of difficulty in understanding English or cognitive impairment.