ID-5184 Wonca Abstracts supplement A-K 13-10-23 - Flipbook - Page 34
WONCA 2023 Supplement 1: WONCA 2023 abstracts (A–K)
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How do Australian general practitioners manage mastitis?
A mixed-methods study using the MedicineInsight database
and interviews with clinicians
Prof Lisa Amir1, Luke Grzeskowiak2, Sharinne Crawford1, Meabh Cullinane1
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La Trobe University, 2Flinders University
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Background
Mastitis is common reason new mothers visit their general practitioner (GP). It is timely to examine how
mastitis is managed in Australian general practice and explore GPs’ use of clinical guidelines (such as
Therapeutic Guidelines: Antibiotic).
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Aim
To describe how GPs around Australia manage lactational mastitis.
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Methods
A convergent mixed-methods design integrated quantitative analysis of a general practice dataset,
with analysis of interviews with GPs. Using the large-scale primary care database, MedicineInsight,
(2011–21), antibiotics prescribed and investigations ordered for mastitis encounters were extracted.
Semistructured interviews were conducted with 14 Australian GPs using Zoom in 2021–22 and
analysed thematically. The Pillar Integration Process was used to develop a joint display table;
qualitative codes and themes were matched with the quantitative items to illustrate similarities or
contrasts in findings.
Results
At the time of first mastitis encounter, 30,319 (88.4%) women received a prescription for an oral
antibiotic, most commonly di/flucloxacillin (16,399 [47.8%]) or cefalexin (11,229 [32.7%]). Among those
presenting with their first mastitis episode, a diagnostic breast ultrasound was ordered for 7.3%, FBE
in 3.5% and breast milk or nipple swab cultures in approximately 1%. Despite being infrequent, the
overall proportion of women receiving any clinical investigations doubled from 2011 to 2022.
Integration of quantitative and qualitative data identified the following themes regarding mastitis
management:
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GPs support continued breastfeeding
antibiotics are central to GPs’ management
antibiotics are mostly prescribed according to Therapeutic Guidelines
analgesia is a gap in the Therapeutic Guidelines
low use of milk culture.
Conclusions
Prescribing antibiotics for mastitis remains central to Australian GPs’ management of mastitis. Overall,
GPs followed principles of antibiotic stewardship, but there is a need to educate GPs about when to
consider ordering investigations.
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