Table 3 Coding examples of personal paradigm steps and respondents

P-diagnosis

Step 1: Record the patient’s medical history through communicating and inquiring

P1,4–8,10

P2–3,9,11

P1,4–5

But now the situation sometimes is that the patients already have taken pills including antibiotics when they come to our CHCS. We think that the patient doesn’t require antibiotics, but the patient’s family insists we do so.(P1)

Insufficient communication with patient

Step 2: Conduct physical examination, including clinical symptoms and signs

P1–3,5–11

P4

–

Step 3: Select laboratory tests and interpret results

P1–11

–

P1,3–5,7–9

This needs a blood test…

We never grow bacterial cultures because our community hospital does not have the equipment to do it. (P3)

Lack of necessary tests

P5,7,10–11

It (laboratory tests) is not used every time; we diagnose according to our own experience sometimes. (P10)

Negligence of tests

Step 4: Use diagnostic facilities

P9–11

–

–

Step 5: Verify the suitability of your P-diagnosis

P1–2, P4–11

P3

P6

Many primary physicians, both the village physicians and township physicians, lack knowledge of the diseases. For example, they do not even know what disease the patient had after the patient’s recovery. These things have happened. (P6)

Uncertainty about diagnosis

P1–2, P4–5, P9

Diagnosis is not very important. Diagnosis is easy because the diseases which we treat in our CHCS are mostly respiratory tract infection and acute gastroenteritis. (P4)

Negligence of diagnosis

Step 6: Define the patient’s problem

P1–11

–

–

Step 7: Specify the therapeutic objective

–

P1–11

–

P-treatment

Step 1: Specify treatment objective

–

P1–11

–

Step 2: Verify the suitability of your P-treatment

P1–11

–

P2–3,5–11

We know very little about AMR in our geographic region right now since we cannot monitor AMR. (P5)

Lack of knowledge

P1, P4

We learn more every time. But even though we learn, the antibiotic is still being used. (P4)

*Step 3: Start the treatment

P1–11

–

P1–2,4-6,8–10

Respiratory disease such as bronchitis and upper respiratory tract infections are usually treated with antibiotics. A lot of antibiotics are used in surgery. (P2)

Antibiotic treatment issue

Step 4: Provide information, instructions and warnings to the patient

P1–2,4-7,11

P3,8–10

P1,4–5,7,11

I told them that ‘you are college students, you should search online,’ but they still not understand. (P4)

Insufficient communication with patient

P2,4,6

Patients need to have a reasonable level of education about their health through a health class at CHCSs. (P6)

Lack of support/education for patients

Step 5: Monitor treatment

P1,4–7,10–11

P2–3,8–9

–

P-drug

Step 1: Specify drug objective

–

P1–11

–

Step 2: Make an inventory of groups of drugs that are effective

P1–11

–

P3–4,10

Oral infection is usually treated with broad-spectrum antibiotics and metronidazole. (P3)

Preference for broad-spectrum antibiotics

Step 3: Choose an effective group according to the relevant criteria

P1–11

–

–

Step 4: Choose a P-drug

P1–7,9

8,10–11

P2,4–5,9

We use the recommended drug, and also consider the patient’s financial situation. Both are important factors. It does not matter if they are not sensitive to the cost of the drug. (P9)

Preference for expensive drug

P-prescription

Step 1: Specify prescribing objective

–

P1–11

–

*Step 2: Choose P-treatment

P1–11

–

P1–2,4-6,8–11

You cannot wait for the test results before you treat the patient. Bacteria multiply very quickly… I have prescribed some antibiotics infusion for patients who demanded aggressively and made me feel vexed. (P11)

Antibiotic treatment issue

Step 3: Choose P-drug

P1–11

–

P2,4–5,9,11

It would be better if patients took oral antibiotics early on. The pollution is still too serious in China. (P4)

Abuse of antibiotics

Step 4: Write the prescription

P4,9,11

P1–3, 5–8, 10

–

Step 5: Provide information, instructions and warnings to the patient

–

P1–11

–

Step 6: Monitor the drug treatment effect

P1,4–6,8,10–11

P2–3,5,7,9

P11

You should consider stopping to use antibiotics if symptoms disappear, for example pneumonia, if the fever has abated but the patient still has a little cough and we find no rales…You should start the treatment early as well as stop it early. (P11)

Pharmacokinetics