Fact or fiction: exploring the use of real stories in place of vignettes in interviews with informal carers.

AIM: To consider the development and use of real stories rather than vignettes in interviews. BACKGROUND: Effective interprofessional working critically informed by the perspectives of informal carers was considered by the research team to be under-researched. It was proposed initially to use fictional vignettes as triggers in interviews with informal carers. It could be argued that the vignette does not represent the voice of the individual or may only represent a particular experience. Stories acknowledge a person's expertise in his or her experiences. A decision was made early in the design process to use real stories instead of vignettes. DATA SOURCES: A descriptive naturalistic design using a participatory approach. Two stories were developed by the researcher and two informal carers, and then used in interviews with other carers to explore their experiences and perceptions of interprofessional working. REVIEW METHODS: The paper provides a discussion of an alternative approach to data collection. DISCUSSION: The stories promoted a sense of support for the participants, which they gained from listening to and sharing stories of caring. This approach offered a different experience for the carers from the standard interview format. CONCLUSION: The paper describes the use of real stories in interviews, which is not a commonly reported method. Carers were involved in both the development and the use of the stories in the interviews. Those interviewed valued the credibility gained by using these real stories, as opposed to constructed vignettes. IMPLICATIONS FOR RESEARCH/PRACTICE: Using stories in this way contributes to methodological development, which allows perceptions and experiences to be captured.

Economic burden of adult pharyngitis: the payer's perspective.

OBJECTIVES: Although not recommended by practice guidelines, physicians frequently prescribe an antibiotic for adults with viral pharyngitis. The financial burden of this practice, from the payer's perspective, has not been previously evaluated. The purpose of this study was to estimate those expenditures. METHODS: A cost-of-illness study was performed to estimate annual expenditures of pharyngitis management from the payer's perspective. National Ambulatory Care Survey data were used to represent current patterns of ambulatory care visits and antibiotic prescriptions for adult pharyngitis. Direct and antibiotic resistance costs were summed to estimate total expenditures for pharyngitis management. Resistance costs were calculated using a model linking the effect of antibiotic consumption to the cost consequences of resistant Streptococcus pneumoniae infection. Sensitivity analyses compared cost outcomes of current practice, adherence to pharyngitis management guidelines from the Infectious Diseases Society of America (IDSA), and nonantibiotic treatment. RESULTS: In the base-case analysis, reflecting current practice patterns, total expenditures were $1.2 billion with antibiotic resistance contributing 36% ($426 million). IDSA guideline adherence decreased costs to $559 million with resistance accounting for 6.8% ($37.9 million). Guideline adherence plus reducing office visits by 30% decreased costs to $372 million, with only 1.4% ($5.3 million) due to resistance. Additional cost-savings of $88 million were realized by using a nonantibiotic treatment strategy. CONCLUSIONS: Current practice imposed a substantial economic burden on the payer, while guideline adherence resulted in cost reductions, especially in terms of resistance, emphasizing that antibiotic prescribing habits have broad economic consequences. Relevant stakeholders, payers, physicians, and other health-care providers should revisit efforts to encourage adherence to pharyngitis guidelines to reduce health-care costs.