Are Patient Views about Antibiotics Related to Clinician Perceptions, Management and Outcome? A Multi-Country Study in Outpatients with Acute Cough

Abstract

BackgroundOutpatients with acute cough who expect, hope for or ask for antibiotics may be more unwell, benefit more from antibiotic treatment, and be more satisfied with care when they are prescribed antibiotics. Clinicians may not accurately identify those patients.ObjectiveTo explore whether patient views (expecting, hoping for or asking for antibiotics) are associated with illness presentation and resolution, whether patient views are accurately perceived by clinicians, and the association of all these factors with antibiotic prescribing and patient satisfaction with care.MethodsProspective observational study of 3402 adult patients with acute cough presenting in 14 primary care networks. Correlations and associations tested with multilevel logistic regression and McNemar ‘s tests, and Cohen’s Kappa, positive agreement (PA) and negative agreement (NA) calculated as appropriate.Results1,213 (45.1%) patients expected, 1,093 (40.6%) hoped for, and 275 (10.2%) asked for antibiotics. Clinicians perceived 840 (31.3%) as wanting to be prescribed antibiotics (McNemar’s test, p<0.05). Their perception agreed modestly with the three patient views (Kappa’s = 0.29, 0.32 and 0.21, PA’s = 0.56, 0.56 and 0.33, NA’s = 0.72, 0.75 and 0.82, respectively). 1,464 (54.4%) patients were prescribed antibiotics. Illness presentation and resolution were similar for patients regardless their views. These associations were not modified by antibiotic treatment. Patient expectation and hope (OR:2.08, 95% CI:[1.48,2.93] and 2.48 [1.73,3.55], respectively), and clinician perception (12.18 [8.31,17.84]) were associated with antibiotic prescribing. 2,354 (92.6%) patients were satisfied. Only those hoping for antibiotics were less satisfied when antibiotics were not prescribed (0.39 [0.17,0.90]).ConclusionPatient views about antibiotic treatment were not useful for identifying those who will benefit from antibiotics. Clinician perceptions did not match with patient views, but particularly influenced antibiotic prescribing. Patients were generally satisfied with care, but those hoping for but not prescribed antibiotics were less satisfied. Clinicians need to more effectively elicit and address patient views about antibiotics.

Access to Point-of-Care Tests Reduces the Prescription of Antibiotics Among Antibiotic-Requesting Subjects With Respiratory Tract Infections

“…This study was not a clinical trial, and the groups were not assigned randomly. The percentage of physicians who stated that subjects had requested an antibiotic was very low in our study (only 1.4%), being much lower than what was reported by Coenen et al, 13 who observed a percentage of 10.2% in a study involving nearly 3,500 adult subjects with acute cough in 14 different European networks. In our study, approximately one third of the infections included corresponded to the common cold; in these cases, the request for an antibiotic was unlikely.…”

“…[9][10][11] There is compelling evidence that patients' satisfaction with the consultation is not affected by prescribing of antibiotics, and patient dissatisfaction has been shown to be significantly related only to poor communication between the patient and the doctor. 12,13 Despite numerous papers on patients' expectations and physicians' perceptions and their impact on antibiotic prescribing for respiratory tract infections, few studies addressing the explicit request for antibiotics by patients during the consultation have been published. GPs often prescribe an antibiotic to fulfill patient demands in an attempt to satisfy the patient.…”

Systematic Review of Factors Associated with Antibiotic Prescribing for Respiratory Tract Infections

“…However, perceptions are not always accurately aligned with patient expectations (27,45). Interestingly, in the study by Coenen et al, patients explicitly asking for antibiotics (as reported by the patient) did not have a significant effect on prescribing, and there was a trend toward reduced prescribing, in contrast to the physician perceiving that a patient was expecting an antibiotic, which was associated with prescribing (44). This suggests that by asking, the patient addresses directly the issue at hand, allowing for a discussion to ensue regarding the need for antibiotics.…”

“…Just over half of the included studies were from the United States (n ϭ 15) (11,20,21,24,26,28,30,31,33,(38)(39)(40)(45)(46)(47), with the remainder from Canada (n ϭ 3) (34,37,43), The Netherlands (n ϭ 2) (29,35), Germany (n ϭ 2) (23, 42), Italy (n ϭ 1) (27), the United Kingdom (n ϭ 1) (25), Belgium (n ϭ 1) (22), and a network of 13 European countries (n ϭ 3) (36,41,44). Eight of the U.S. studies used the NAMCS (National Ambulatory Medical Care Survey) or NHAMCS (National Hospital Ambulatory Medical Care Survey) data sets for their analyses (11,28,31,33,(38)(39)(40)46).…”

Prevalence of Parental Misconceptions About Antibiotic Use

“…12,26,27 Whether the responses to these items reflect lower parent-provider trust would be important to determine in order to find ways to meet patients' needs while still decreasing unnecessary antibiotic use. 43 The survey included assessment of sources parents rely on for their medical information. Across insurance type, parents place high trust in their health care providers.…”