Antibiotics for coughing in general practice: a questionnaire study to quantify and condense the reasons for prescribing

Coenen, Samuel; Michiels, Bart; Royen, Paul Van; Auwera, Jean-Claude Van der; Denekens, Joke

doi:10.1186/1471-2296-3-16

Cited by 40 publications

(37 citation statements)

References 26 publications

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“…[1][2][3][4][5] These suggestions have emerged from studies on how best to conduct consultations when antibiotics are deemed clinically inappropriate, but are nevertheless prescribed because of patient or parent expectations for antibiotics, as perceived by their physician. 3,6,7 Researchers have found that physicians rarely seek patient expectations, and by failing to do so, their perceptions of patient expectations can be unreliable and may indeed overestimate actual patient demand. 2,3,7,8 Various interventions seeking to facilitate the direct elicitation, and also the shaping, of patient expectations have been developed and evaluated.…”

mentioning

confidence: 99%

Managing Expectations of Antibiotics for Upper Respiratory Tract Infections: A Qualitative Study

Mustafa

Wood

Butler

et al. 2014

The Annals of Family Medicine

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PURPOSE Communication experts have suggested that it is good practice to ask patients' directly whether they expect to receive antibiotics as part of asking about the triad of ideas, concerns, and expectations for health care. Our aim was to explore the views and experiences of family physicians about using this strategy with their patients, focusing the interview on the problem of eliciting expectations of antibiotics as a possible treatment for upper respiratory tract infections. METHODSWe conducted a qualitative study using semistructured interviews with 20 family physicians in South Wales, United Kingdom, and performing thematic analysis. RESULTSFamily physicians assumed most patients or parents wanted antibiotics, as well as wanting to be "checked out" to make sure the illness was "nothing serious." Physicians said they did not ask direct questions about expectations, as that might lead to confrontation. They preferred to elicit expectations for antibiotics in an indirect manner, before performing a physical examination. The majority described reporting their findings of the examination as a "running commentary" so as to influence expectations and help avoid generating resistance to a soon-tobe-made-explicit plan not to prescribe antibiotics. The physicians used the running commentary to preserve and enhance the physician-patient relationship.CONCLUSIONS Real-world family physicians use indirect methods to explore expectations for treatment and, on the basis of their physical examination, build an argument for reassuring the patient or parent. In contrast to proposed models in the communication literature, interventions to promote appropriate antibiotic prescribing might include a focus on training in communication skills that (1) integrates these indirect methods as part of building collaborative physicianpatient relationships and (2) uses the running commentary of examination findings to facilitate participation in clinical decisions. 2014;29-36. doi:10.1370/afm.1583. Ann Fam Med INTRODUCTIONI n an attempt to achieve more appropriate prescribing of antibiotics for self-limiting conditions such as acute upper respiratory tract infections (URTIs), many communication experts suggest that physicians directly determine whether patients, or parents, expect to receive antibiotics. [1][2][3][4][5] These suggestions have emerged from studies on how best to conduct consultations when antibiotics are deemed clinically inappropriate, but are nevertheless prescribed because of patient or parent expectations for antibiotics, as perceived by their physician. 3,6,7 Researchers have found that physicians rarely seek patient expectations, and by failing to do so, their perceptions of patient expectations can be unreliable and may indeed overestimate actual patient demand. 2,3,7,8 Various interventions seeking to facilitate the direct elicitation, and also the shaping, of patient expectations have been developed and evaluated. They include communication skills training, the possible use of running commentaries to co...

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confidence: 99%

Managing Expectations of Antibiotics for Upper Respiratory Tract Infections: A Qualitative Study

Mustafa

Wood

Butler

et al. 2014

The Annals of Family Medicine

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“…Physicians commonly ask their patients about the colour of their sputum and how unwell they are feeling to inform their decision of whether or not to prescribe an antibiotic for acute cough, based on the assumption that purulence is more likely to reflect a bacterial cause and predict improved outcomes from antibiotics [6][7][8]. Clinicians regard patients who feel both systemically unwell and who also produce discoloured sputum an even higher priority for an antibiotic prescription [9][10][11]. Guidelines identify purulent sputum as one of a cluster of clinical features that should alert clinicians to possible serious lung infection [12].…”

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Antibiotic prescribing for discoloured sputum in acute cough/lower respiratory tract infection

Butler¹,

Kelly²,

Hood³

et al. 2011

European Respiratory Journal

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We investigated whether discoloured sputum and feeling unwell were associated with antibiotic prescription and benefit from antibiotic treatment for acute cough/lower respiratory tract infection (LTRI) in a prospective study of 3,402 adults in 13 countries.A two-level model investigated the association between producing discoloured sputum or feeling generally unwell and an antibiotic prescription. A three-level model investigated the association between an antibiotic prescription and symptom resolution.Patients producing discoloured sputum were prescribed antibiotics more frequently than those not producing sputum (OR 3.2, 95% CI 2.1-5.0), unlike those producing clear/white sputum (OR 0.95, 95% CI 0.61-1.48). Antibiotic prescription was not associated with a greater rate or magnitude of symptom score resolution (as measured by a 13-item questionnaire completed by patients each day) among those who: produced yellow (coefficient 0.00; p50.68) or green (coefficient -0.01; p50.11) sputum; reported any of three categories of feeling unwell; or produced discoloured sputum and felt generally unwell (coefficient -0.01; p50.19).Adults with acute cough/LRTI presenting in primary care settings with discoloured sputum were prescribed antibiotics more often compared to those not producing sputum. Sputum colour, alone or together with feeling generally unwell, was not associated with recovery or benefit from antibiotic treatment.

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“…Thus in patients with acute respiratory infections yellowish and greenish sputum as well as certain non-specific symptoms such as fatigue are strong predictors for antibiotic prescribing in primary care [4,11,12]. So far there has been no evidence that discoloured sputum is correlated with a bacterial aetiology of acute respiratory infections in otherwise healthy adults.…”

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Sputum colour for diagnosis of a bacterial infection in patients with acute cough

Altiner

Wilm

Däubener

et al. 2009

Scandinavian Journal of Primary Health Care

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Antibiotics for coughing in general practice: a questionnaire study to quantify and condense the reasons for prescribing

Cited by 40 publications

References 26 publications

Managing Expectations of Antibiotics for Upper Respiratory Tract Infections: A Qualitative Study

Managing Expectations of Antibiotics for Upper Respiratory Tract Infections: A Qualitative Study

Antibiotic prescribing for discoloured sputum in acute cough/lower respiratory tract infection

Sputum colour for diagnosis of a bacterial infection in patients with acute cough

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