Results from a Patient-Based Health Education Intervention in Reducing Antibiotic Use for Acute Upper Respiratory Tract Infections in the Private Sector Primary Care Setting in Singapore

Abstract

We investigated the efficacy of patient-targeted education in reducing antibiotic prescriptions for upper respiratory tract infections (URTIs) among adults in the private primary care setting in Singapore. Our randomized controlled trial enrolled patients aged 21 years and above presenting at general practitioner (GP) clinics with URTI symptoms for 7 days or less. Intervention arm patients were verbally educated via pamphlets about the etiology of URTIs, the role of antibiotics in treating URTIs, and the consequences of inappropriate antibiotic use. Control arm patients were educated on influenza vaccinations. Both arms were compared regarding the proportions prescribed antibiotics and the patients' postconsultation views. A total of 914 patients consulting 35 doctors from 24 clinics completed the study (457 in each arm). The demographics of patients in both arms were similar, and 19.1% were prescribed an antibiotic, but this varied from 0% to 70% for individual GPs. The intervention did not significantly reduce antibiotic prescriptions (odds ratio [OR], 1.20; 95% confidence interval [CI], 0.83–1.73) except in patients of Indian ethnicity (OR, 0.28; 95% CI, 0.09–0.93). Positive associations between the intervention and the view that antibiotics were not needed most of the time for URTIs (P = 0.047) and on being worried about the side effects of antibiotics (P = 0.018) were restricted to the Indian subgroup. GPs in limited liability partnerships or clinic chains prescribed less (OR, 0.36; 95% CI, 0.14 to 0.92), while certain inappropriate patient responses were associated with the receipt of antibiotics. Follow-up studies to investigate differences in responses to educational programs between ethnicities and to explore GP-targeted interventions are recommended.

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

“…However, some children can develop pneumonia, which requires hospitalization and specialized treatment 198 . Despite URTIs generally being minor illnesses, they result in an appreciable number of medical consultations globally 87,[199][200][201][202][203] . The number of healthcare consultations combined with parental and patient pressure increases antibiotic use for URTIs including LMICs thereby increasing AMR rates 88,153,200,[204][205][206][207][208][209] .…”

“…Despite URTIs generally being minor illnesses, they result in an appreciable number of medical consultations globally 87,[199][200][201][202][203] . The number of healthcare consultations combined with parental and patient pressure increases antibiotic use for URTIs including LMICs thereby increasing AMR rates 88,153,200,[204][205][206][207][208][209] . Patients or parents who are concerned about their or their child's respiratory illness are likely to seek treatment, and want an antibiotic, especially if they perceive the illness as severe 21,209,210 .…”

Using Leaflets to Reduce Inappropriate Antibiotics for Upper Respiratory Infections

“…As mentioned before, the unnecessary use of antibiotics to treat upper respiratory infections leads to consequences like increased drug-resistance, increased health care costs, and increased incidences of adverse effects (O'Sullivan, Harvey, Glasziou, & McCullough, 2016;Lee et al, 2017). Uncomplicated URIs result in 25 million visits to primary care providers across the United States each year (Zoorob, Sidani, Fremont, &Kihlberg, 2013).…”

“…An evidence-based review of numerous research studies aimed at reducing antibiotic prescriptions for upper respiratory infections was conducted using PubMed, Google Scholar, and various online resources (e.g., CDC, UpToDate). From these resources, five studies were found to show that printed information given to patients presenting with upper respiratory infections would result in reduced prescription rates for antibiotics (Lee et al, 2017;Wei et al, 2017;Gonzales et al, 2013;Agnew, Taaffe, Darker, O'Shea, & Clarke,2013;Meeker et al, 2014). The use of printed information would come in various forms, including leaflets, brochures, pamphlets, and a poster-size education/commitment letter (Lee et al, 2017;Wei et al, 2017;Gonzales et al, 2013;Agnew et al,2013;Meeker et al, 2014).…”

“…Gabriel Barajas & Annie Huynh 3 This evidence-based review is aimed at evaluating the use of printed information for patients, and will address the following research question: Will providing information leaflets to adult patients with upper respiratory infections reduce the use of antibiotics? Lee et al (2017) designed a patient-targeted educational pamphlet on the causes of URIs and the role of antibiotics, with a goal of reducing antibiotic prescriptions. The educational pamphlet was based on information from the Health Promotion Board of Singapore, the CDC of the United States, and consultations from several primary care and infectious disease providers, and public health experts (Lee et al, 2017).…”