Reducing Expectations for Antibiotics in Patients With Upper Respiratory Tract Infections: A Primary Care Randomized Controlled Trial

Abstract

PURPOSE Many family practitioners prescribe antibiotics for patients with upper respiratory tract infections (URTIs) to meet patients' expectations. We evaluated the impact of providing brief tablet-based information about antibiotic treatment of URTIs on patients' expectations for antibiotics and on family practitioners' antibiotic-prescribing behavior.METHODS We performed a 3-arm randomized controlled trial among patients presenting with URTIs at 2 urban family practices in Auckland, New Zealand, during winter 2018. Participants were randomly allocated to view a presentation about the futility of antibiotic treatment of URTIs, the adverse effects associated with antibiotics, or the benefits of healthy diet and exercise (active control), immediately before their consultation. Before and after viewing the presentations, participants used a Likert scale to rate the strength of their belief that antibiotics are effective for treating URTIs and of their desire to be prescribed an antibiotic. Patients reported whether an antibiotic had been prescribed, and pharmacy dispensing records were reviewed to determine whether an antibiotic was dispensed. RESULTSParticipants who viewed either the futility or the adverse effects presentation had greater reductions in their expectations to receive antibiotics than the control group. The mean reduction (95% CI) was 1.1 (0.8-1.3) for the futility group, 0.7 (0.4-0.9) for the adverse effects group, and 0.1 (0-0.3) for the control group (Cohen d = 0.7; P <.001). There was no significant difference among the 3 groups with regard to antibiotic prescribing (P = .84) or dispensing (P = .43).CONCLUSIONS A brief tablet-based waiting room intervention significantly reduced participants' expectations about receiving antibiotics for URTI immediately before their family practitioner consultation. The intervention did not influence family practitioner prescribing behavior, however.

Association of antibiotics with veteran visit satisfaction and antibiotic expectations for upper respiratory tract infections

“…Previous research has shown that it is feasible to change patients' expectations for antibiotics for URIs. 29 Additionally, communicating these findings to providers may empower them to assess and address patients' expectations by implementing successful interventions like communications training. [30][31][32] Patient satisfaction with URI visits has been shown to be a If Veterans answered at least one item within a subscale, they were included; however, some Veterans did not answer any items within a specific subscale and therefore the total N used in calculating means scores differed.…”

Māori Experiences and Beliefs about Antibiotics and Antimicrobial Resistance for Acute Upper Respiratory Tract Symptoms: A Qualitative Study

“…Unfortunately for Māori in NZ, there is both under-prescribing of necessary treatments and over-prescribing of inappropriate medications [ 21 ], creating and sustaining health inequities [ 4 , 5 ]. There is potential for ‘good prescribing’ when patients and their prescribers discuss the reasons for the medicine, including risks and benefits [ 1 , 17 , 18 ]. Our findings suggest a need to address the relationship between health providers and Māori ‘10,21].…”

“…The interview process consisted of a 20- to 40-minute discussion using a semi-structured guide ( Supplementary File S2 ) developed by the research team based on their research experience and on the published literature [ 16 , 17 ]. The investigator team reviewed the interview guide and pilot tested the wording of the questions for clarity and flow.…”

“…Understanding people’s beliefs and perceptions about antibiotics is important for informing antimicrobial stewardship initiatives, as perceptions can have a significant influence on the patient-health professional interaction and can impact antibiotic use [ 16 , 17 ]. General practitioners have suggested that interventions that target the public and their perceptions of antibiotics would be useful to reduce unnecessary prescribing [ 12 ].…”

Post-consultation acute respiratory tract infection recovery: a latent class-informed analysis of individual patient data

“…Studies have identified the importance of good clinician-patient communication in reducing inappropriate use of antibiotics (8,9). Patients often do not expect antibiotics for acute RTI, but instead seek reassurance and information on what to expect (10,11,12). Similarly, physicians often face uncertainty about the natural course of RTIs, and who is more likely to experience complications (13).…”