Weighing patient attributes in antibiotic prescribing for upper respiratory tract infections: A discrete choice experiment on primary care physicians in Hubei Province, China

Abstract

ObjectivesThis study aimed to determine how primary care physicians weigh intervenable patient attributes in their decisions of antibiotic prescribing for upper respiratory tract infections (URTIs).MethodsA discrete choice experiment (DCE) was conducted on 386 primary care physicians selected through a stratified cluster sampling strategy in Hubei province, China. The patient attributes tested in the DCE were identified through semi-structured interviews with 13 primary care physicians, while the choice scenarios were determined by a D-efficient design with a zero prior parameter value. Conditional logit models (CL) and mixed logit models (MXL) were established to determine the preference of the study participants in antibiotic prescribing for URTI patients with various attributes. Relative importance (RI) was calculated to reflect the influence of each attribute.ResultsIn addition to age and duration of symptoms, the interventionable patient attributes were also considered by the primary care physicians in their antibiotic prescribing decisions. They preferred to prescribe antibiotics for URTI patients with difficulties to schedule a follow-up appointment (p < 0.001) and for those without a clear indication of refusal to antibiotics (p < 0.001). Patient request for antibiotics had an RI ranging from 15.2 to 16.3%, compared with 5.1–5.4% for easiness of follow-up appointment. The influence of these two interventionable patient attributes was most profound in the antibiotic prescribing decisions for patients aged between 60 and 75 years as indicated by their interaction effects with age (β = 0.69 for request for antibiotics, p < 0.01; β = −1.2 for easiness of follow-up, p < 0.001).ConclusionReducing patient pressure and improving accessibility and continuity of care may help primary care physicians make rational antibiotic prescribing decisions for URTIs.

Preference of primary care patients for home-based healthcare and support services: a discrete choice experiment in China

“…The main effects were calculated using an optimal orthogonal design based on the differences assumption with zero priors ( 62 , 63 ). A Mixed Logit model (MIXL) was constructed, a choice favored by the literature for comprehensive population preference analysis on a large scale ( 64 – 66 ).…”

Antibiotic Culture: A History of Antibiotic Use in the Second Half of the 20th and Early 21st Century in the People’s Republic of China

“…Some rural residents reported stocking up on or consuming antibiotics prophylactically against colds [ 46 ]. If the desirability for antibiotics over the first three decades of the PRC was linked to the prestige derived from their use, the inability to access quality hospital care now counts as a major driver for the high-level consumer demand for antibiotics in the PRC [ 47 , 48 ]. Being able to purchase antibiotics with health insurance was also associated with higher rates of antibiotic self-medication [ 49 , 50 ].…”