Influence of patients' expectations on antibiotic management of acute lower respiratory tract illness in general practice: questionnaire study

Abstract

Objective: To assess direct and indirect evidence of active infection which may benefit from further antibiotics in adults who reconsult within 4 weeks of initial antibiotic management of acute lower respiratory tract infection in primary care. Design: Observational study with a nested case-control group. Setting: Two suburban general practices in Arnold, Nottingham, over 7 winter months. Subjects: 367 adults aged 16 years and over fulfilling a definition of lower respiratory tract infection and treated with antibiotics. 74 (20%) patients who reconsulted within 4 weeks for the same symptoms and 82 "control" patients who did not were investigated in detail at follow up. Main outcome measures: Direct and indirect evidence of active infection at the time of the reconsultation or the follow up visit with the research nurse for the controls. Investigations performed included sputum culture, pneumococcal antigen detection, serial serology for viral and atypical pathogens and C reactive protein, throat swabs for detecting viral and atypical pathogens by culture and polymerase chain reaction, and chest radiographs.

Delayed prescribing for upper respiratory tract infections: a qualitative study of GPs' views and experiences

“…16 This could be because the prescribing is influenced by the doctor's impression of patient expectations. 17,18 Outpatient antibiotic use is relatively low in Norway; that is, at the same level as other Northern European countries. 3,5 In addition, research suggests that Norwegian patients do not necessarily expect antibiotics for the treatment of URTIs.…”

12 Arzt-Patienten-Kommunikation

“…Dies wird offenbar von einigen Ärzten als fast beweisend für eine bakterielle Infektion angenommen und daraus die Indikation für eine AntibiotikaTherapie abgeleitet. 52,53 Diese Annahme stützt sich allerdings für akuten Infektbedingten Husten nicht auf gesicherte medizinische Evidenz. 44,45 Partielle Wissensdefizite können jedoch die hohe Anzahl unnötiger Antibiotikaverordnungen in allen Industrienationen nicht annähernd ausreichend erklären.…”

“…49,50,,51 Es wurde vermutetet, dass "Zeitdruck" ein wesentlicher Faktor für nicht-indizierte Verordnungen sei. 52 Neuere Untersuchungen zeigen jedoch, dass dies eher ein von Ärzten selbst als Begründung vorgeschobenes Argument zu sein scheint, da es keinen Zusammenhang zwischen der Zeitdauer der Konsultation und der Wahrscheinlichkeit für die Verordnung eines Antibiotikums gibt. 43,52 Tatsächlich scheinen die ausschlaggebenden Gründe für die Verordnung in komplexeren Phänomenen begründet zu liegen.…”

Views on respiratory tract symptoms and antibiotics of Dutch general practitioners, practice staff and patients

“…In case of respiratory tract symptoms, GPs tend to believe more than patients that these symptoms are self-limiting and not serious [17], while patients are not aware of the viral aetiology and overestimate effectiveness of antibiotics [20]. Patients' views and especially GPs' perception of patients' views towards medication seem to have a major influence on GPs' management of respiratory tract symptoms, especially regarding prescribing antibiotics [21][22][23][24][25]. Cockburn and Pit showed in an Australian study that patients who expected to receive medication were nearly three times more likely to actually receive medication, and GPs who perceived that patients expected to receive medication prescribed 10 times more than those who did not perceive [26].…”