Expectations for antibiotics increase their prescribing: Causal evidence about localized impact.

Abstract

Objective: Clinically irrelevant but psychologically important factors such as patients' expectations for antibiotics encourage overprescribing. We aimed to (a) provide missing causal evidence of this effect, (b) identify whether the expectations distort the perceived probability of a bacterial infection either in a preor postdecisional distortions pathway, and (c) detect possible moderators of this effect. Method: Family physicians expressed their willingness to prescribe antibiotics (Experiment 1, n 1 ϭ 305) or their decision to prescribe (Experiment 2, n 2 ϭ 131) and assessed the probability of a bacterial infection in hypothetical patients with infections either with low or high expectations for antibiotics. Response order of prescribing/probability was manipulated in Experiment 1. Results: Overall, the expectations for antibiotics increased intention to prescribe (Experiment 1, F(1, 301) ϭ 25.32, p Ͻ .001, p 2 ϭ .08, regardless of the response order; Experiment 2, odds ratio [OR] ϭ 2.31, and OR ϭ 0.75, Vignettes 1 and 2, respectively). Expectations for antibiotics did not change the perceived probability of a bacterial infection (Experiment 1, F(1, 301) ϭ 1.86, p ϭ .173, p 2 ϭ .01, regardless of the response order; Experiment 2, d ϭ Ϫ0.03, and d ϭ ϩ0.25, Vignettes 1 and 2, respectively). Physicians' experience was positively associated with prescribing, but it did not moderate the expectations effect on prescribing. Conclusions: Patients' and their parents' expectations increase antibiotics prescribing, but their effect is localized-it does not leak into the perceived probability of a bacterial infection. Interventions reducing the overprescribing of antibiotics should target also psychological factors.

‘Always take your doctor’s advice’: Does trust moderate the effect of information on inappropriate antibiotic prescribing expectations?

“…During a primary care consultation, the patient’s behaviour exerts a powerful influence on whether a physician will withhold or prescribe antibiotics (Macfarlane, Holmes, Macfarlane, & Britten, 1997). Patient expectations for antibiotics have been identified as a particularly important factor in the overprescribing of antibiotics in primary care (McNulty, Nichols, French, Joshi, & Butler, 2013; Pan et al , 2016; Sirota, Round, Samaranayaka, & Kostopoulou, 2017). Patients who expect antibiotics from a physician almost always receive them (McNulty et al , 2013).…”

“…Patients who expect antibiotics from a physician almost always receive them (McNulty et al , 2013). Building on these findings, Sirota et al (2017) provided causal evidence that patients’ expectations to receive antibiotics are sufficient to actuate physicians to prescribe them – even when they are not clinically justified (i.e., inappropriate).…”

Knowledge and Expectations on Antibiotic Use among Older Adults in Malaysia: A Cross-Sectional Survey

“…Studies have found that those who incorrectly believed that antibiotics will work for viral infections were more likely to expect antibiotics from prescribers [30,31]. Patients' expectations of antibiotics are found to be an important predictor of antibiotic prescribing [32,33]. Expectations for antibiotics for common cold were found among older adults when they felt sick enough to visit a physician, although most of them disagreed that antibiotics could speed the recovery [24].…”

Improving Management of Respiratory Tract Infections in Community Pharmacies and Promoting Antimicrobial Stewardship: A Cluster Randomised Control Trial with a Self-Report Behavioural Questionnaire and Process Evaluation

“…These interventions have the potential to support the government's ambition to reduce inappropriate antibiotic consumption [1], particularly since interventions that help to both reduce referrals to GPs and inform patients on the appropriate use of antibiotics (including when they are necessary or unnecessary) may reduce patient expectation to receive antibiotics for self-limiting infections, and in turn reduce pressure on GPs to prescribe antibiotics when they are not needed [14]. The leaflet, which is available at no cost from the TARGET website (www.rcgp.org.uk/targetantibiotics), can support efforts to raise awareness on the appropriate use of antibiotics, use of available resources, and signpost to sources of advice and information (for instance, directing patients and customers to the Antibiotic Guardian website, a pledge-based campaign website) (www.antibioticguardian.com).…”