Patients’ and Clinicians’ Perceptions of Antibiotic Prescribing for Upper Respiratory Infections in the Acute Care Setting

Abstract

Reducing inappropriate prescribing is key to mitigating antibiotic resistance, particularly in acute care settings. Clinicians' prescribing decisions are influenced by their judgments and actual or perceived patient expectations. Fuzzy trace theory predicts that patients and clinicians base such decisions on categorical gist representations that reflect the bottom-line understanding of information about antibiotics. However, due to clinicians' specialized training, the categorical gists driving clinicians' and patients' decisions might differ, which could result in mismatched expectations and inefficiencies in targeting interventions. We surveyed clinicians and patients from 2 large urban academic hospital emergency departments (EDs) and a sample of nonpatient subjects regarding their gist representations of antibiotic decisions, as well as relevant knowledge and expectations. Results were analyzed using exploratory factor analysis (EFA) and multifactor regression. In total, 149 clinicians (47% female; 74% white), 519 online subjects (45% female; 78% white), and 225 ED patients (61% female; 56% black) completed the survey. While clinicians demonstrated greater knowledge of antibiotics and concern about side effects than patients, the predominant categorical gist for both patients and clinicians was "why not take a risk," which compares the status quo of remaining sick to the possibility of benefit from antibiotics. This gist also predicted expectations and prior prescribing in the nonpatient sample. Other representations reflected the gist that "germs are germs" conflating bacteria and viruses, as well as perceptions of side effects and efficacy. Although individually rational, reliance on the "why not take a risk" representation can lead to socially suboptimal results, including antibiotic resistance and individual patient harm due to adverse events. Changing this representation could alter clinicians' and patients' expectations, suggesting opportunities to reduce overprescribing.

Risks of use and non-use of antibiotics in primary care: qualitative study of prescribers’ views

“…Among hospital doctors, there is evidence that overtreatment is preferred to the potential for adverse patient outcomes from not prescribing. 18 19 Klein et al 20 and Broniatowski et al, 21 for example, demonstrate that medical decision-making tends to favour views that favour prescription (‘why take risks’) rather than on prescription avoidance (‘antibiotics can be harmful’). In primary care, general practitioners (GPs) and other prescribers also deal with safety concerns in their decision-making, and a better understanding needs to be developed concerning the balance of risk between prescribing or non-prescribing of antibiotics.…”

A system dynamics model of infection risk, expectations, and perceptions on antibiotic prescribing in the United States

“…Desire for antibiotics is related to lack of knowledge about antibiotic resistance and previous experience of antibiotic use for an ARTI condition . Awareness of damaging effects of antibiotics can change patients' and providers' perceptions and reduce its overuse …”

The Effect of Expert Feedback on Antibiotic Prescribing in Pediatrics: Experimental Evidence

“…It is true that we elicited hypothetical treatment decisions and that our experimental frame is parsimonious, used a set of hypothetical cases, and did not allow physicians to acquire additional information to assess the cases further. More specifically, one might argue that we were unable to consider pediatricians' responses to influencing factors, which are relevant in real-world clinical settings but might go beyond the constructed case descriptions (e.g., parental expectations 47 or risk and efficacy perceptions 75 ). Second, different interpretations of the same case information may have affected individual physicians' judgments of the cases and their treatment decisions.…”