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Understanding determinants of patients' decisions to attend their family physician and to take antibiotics for upper respiratory tract infections: a qualitative descriptive study.

ABSTRACT: BACKGROUND:Although antibiotics have little or no benefit for most upper respiratory tract infections (URTIs), they continue to be prescribed frequently in primary care. Physicians perceive that patients' expectations influence their antibiotic prescribing practice; however, not all patients seek antibiotic treatment despite having similar symptoms. In this study, we explored patients' views about URTIs, and the ways patients manage them (including attendance in primary care and taking antibiotics). METHODS:Using a qualitative descriptive design, adult English-speaking individuals at a Canadian health center were recruited through convenient sampling. The participants were interviewed using semi-structured interview guide based on the Common Sense-Self-Regulation Model (CS-SRM). The interviews were transcribed verbatim and coded according to CS-SRM dimensions (illness representations, coping strategies). Sampling continued until thematic saturation was achieved. Thematic analysis related to the dimensions of CS-SRM was applied. RESULTS:Generally, participants had accurate perception about the symptoms of URTIs, as well as how to prevent and manage them. However, some participants revealed misconceptions about the causes of URTIs. Almost all participants mentioned that they only visited their doctor if their symptoms got progressively worse and they could no longer self-manage the symptoms. When visiting a doctor, most participants reported that they did not seek antibiotics. They expected to receive an examination and an explanation for their symptoms. CONCLUSION:Our participants reported good understanding regarding the likely lack of benefit from antibiotics for URTIs. Developing interventions that specifically help patients discuss their concerns with their physicians, instead of providing more education to public may help in reducing the use of unnecessary antibiotics.

SUBMITTER: Mortazhejri S

PROVIDER: S-EPMC7313109 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Understanding determinants of patients' decisions to attend their family physician and to take antibiotics for upper respiratory tract infections: a qualitative descriptive study.

Mortazhejri Sameh S Patey Andrea M AM Stacey Dawn D Bhatia R Sacha RS Abdulla Alykhan A Grimshaw Jeremy M JM

BMC family practice 20200624 1

<h4>Background</h4>Although antibiotics have little or no benefit for most upper respiratory tract infections (URTIs), they continue to be prescribed frequently in primary care. Physicians perceive that patients' expectations influence their antibiotic prescribing practice; however, not all patients seek antibiotic treatment despite having similar symptoms. In this study, we explored patients' views about URTIs, and the ways patients manage them (including attendance in primary care and taking a ...[more]

PMID: 32580696

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Project description:ObjectivesTo investigate the decision-making process of Chinese university students with respect to antibiotic use for upper respiratory tract infections (URTIs).DesignA cross-sectional questionnaire study.SettingThe participants recruited from six universities across all Chinese regions from September to November 2015.ParticipantsA total of 2834 university students sampled across six Chinese regions who self-reported experiencing symptoms of URTI within the past month completed the survey.Outcome measuresThe prevalence of decisions for treatment and antibiotic use for URTIs as well as knowledge about antibiotic use were measured by a self-administrated questionnaire. Using regular and multinomial logistic regression a nd adapted health belief model, we identified and measured a number of variables as potential risk factors for antibiotic misuse behaviours in order to explain and predict people's treatment decisions and antibiotic use including knowledge, perceptions, access to antibiotics and cues to action.ResultsOf the 2834 university students who self-diagnosed a URTI, 947 (33.4%) self-reported having taken antibiotics; among them, 462 (48.8%) used non-prescription antibiotics, which came principally from left-over prescriptions (29.0%) and over-the-counter purchases at retail pharmacies (67.3%). One in four who sought care pressured their doctors for antibiotics; all received them. Those who perceived greater severity of the disease, had access to antibiotics, perceived benefits of using antibiotics (for the common cold: adjusted OR (aOR)=2.55, 95% CI 1.93 to 3.38 or as anti-inflammatory drugs: aOR=1.35, 95% CI 1.12 to 1.63), and were cued to action (eg, seeing presence of fever: aOR=2.05, 95% CI 1.62 to 2.60 or self-diagnosing their current infection as severe: aOR=1.86, 95% CI 1.41 to 2.45), keeping antibiotics at home (aOR=2.27, 95% CI 1.83 to 2.81) and access to over-the-counter antibiotics (aOR=2.00, 95% CI 1.63 to 2.45), were more likely to misuse antibiotics.ConclusionsMisconceptions of antibiotic efficacy and easy access to antibiotics-with or without a prescription-were associated with antibiotic misuse among Chinese university students, which calls for context-appropriate multifaceted interventions in order to effectively reduce antibiotic misuse.

Project description:BackgroundReducing antimicrobial resistance (AMR) is a priority for public health. Inappropriate patient demand is an important driver of unnecessary antibiotic use. To develop an effective intervention to reduce inappropriate demand for antibiotics in upper respiratory tract infections (URTIs), it is important to identify patient perceptions that influence demand for, and appropriate use of antibiotics.AimTo identify and describe the beliefs about antibiotics necessity and concerns that patients with URTIs have, in Riyadh, Saudi Arabia.MethodAn exploratory qualitative approach was used. One-to-one, face-to-face or telephone semi-structured interviews were conducted with participants recruited using purposive sampling (based on age and gender) from primary healthcare centre in Riyadh, Saudi Arabia were conducted. Only adult patients who currently experience URTIs symptoms and agreed to participate were recruited. Recruitment for interviews continued until data saturation point was reached. The interview guide explored patients' necessity beliefs and concerns about antibiotics, AMR perceptions, and expectations from URTIs consultation. Interview transcripts were coded using QSR NVivo 12 using framework analysis informed by the Necessity-Concerns Framework to identify key motivations driving antibiotic requests and consultations.Resultsthe study interviewed 32 participants (44% were male, average age was 36.84). Results identified that the patients often relate their personal need for antibiotics when encountering an URTIs symptoms to the type, severity and duration of symptoms. Patients also linked antibiotics with quicker recovery, generally expressing few concerns about antibiotics mainly because of its short duration of use. However, some conveyed their concern about frequent administration of antibiotics and effect on the body's immune system function, which may make them more prone to infections in the future. Participants varied widely in their awareness of AMR; this was associated with many misconceptions, such as confusing AMR with antibiotics efficacy and tolerance. Interestingly, the interplay between necessity beliefs and concerns was observed to influence the decision to start and stop antibiotic, potentially impacting inappropriate antibiotic demand and unnecessary use.ConclusionThis study highlighted important beliefs and misconceptions about antibiotics and AMR in Saudi population which can be targeted in future interventions to reduce inappropriate demand for antibiotics and optimise appropriate usage.

Project description:BackgroundMedical end-of-life decisions (MELD) and shared decision-making are increasingly important issues for a majority of persons at the end of life. Little is known, however, about the impact of physician characteristics on these practices. We aimed at investigating whether MELDs depend on physician characteristics when controlling for patient characteristics and place of death.Methods and findingsUsing a random sample (N = 8,963) of all deaths aged 1 year or older registered in Switzerland between 7 August 2013 and 5 February 2014, questionnaires covering MELD details and physicians' demographics, life stance and medical formation were sent to certifying physicians. The response rate was 59.4% (N = 5,328). Determinants of MELDs were analyzed in binary and multinomial logistic regression models. MELDs discussed with the patient or relatives were a secondary outcome. A total of 3,391 non-sudden nor completely unexpected deaths were used, 83% of which were preceded by forgoing treatment(s) and/or intensified alleviation of pain/symptoms intending or taking into account shortening of life. International medical graduates reported forgoing treatment less often, either alone (RRR = 0.30; 95% CI: 0.21-0.41) or combined with the intensified alleviation of pain and symptoms (RRR = 0.44; 0.34-0.55). The latter was also more prevalent among physicians who graduated in 2000 or later (RRR = 1.60; 1.17-2.19). MELDs were generally less frequent among physicians with a religious affiliation. Shared-decision making was analyzed among 2,542 decedents. MELDs were discussed with patient or relatives less frequently when physicians graduated abroad (OR = 0.65, 95% CI: 0.50-0.87) and more frequently when physicians graduated more recently; physician's sex and religion had no impact.ConclusionsPhysicians' characteristics, including the country of medical education and time since graduation had a significant effect on the likelihood of an MELD and of shared decision-making. These findings call for additional efforts in physicians' education and training concerning end-of-life practices and improved communication skills.

Project description:BACKGROUND:Antibiotics are prescribed frequently for upper respiratory tract infections (URTIs) even though most URTIs do not require antibiotics. This over-prescription contributes to antibiotic resistance which is a major health problem globally. As physicians' prescribing behaviour is influenced by patients' expectations, there may be some opportunities to reduce antibiotic prescribing using patient-oriented interventions. We aimed to identify these interventions and to understand which ones are more effective in reducing unnecessary use of antibiotics for URTIs. METHODS:We conducted a systematic review by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (OVID), EMBASE (OVID), CINAHL, and the Web of Science. We included English language randomized controlled trials (RCTs), quasi-RCTs, controlled before and after studies, and interrupted time series (ITS) studies. Two authors screened the abstract/titles and full texts, extracted data, and assessed study risk of bias. Where pooling was appropriate, a meta-analysis was performed by using a random-effects model. Where pooling of the data was not possible, a narrative synthesis of results was conducted. RESULTS:We included 13 studies (one ITS, one cluster RCTs, and eleven RCTs). All interventions could be classified into two major categories: delayed prescriptions (seven studies) and patient/public information and education interventions (six studies). Our meta-analysis of delayed prescription studies observed significant reductions in the use of antibiotics for URTIs (OR = 0.09, CI 0.03 to 0.23; six studies). A subgroup analysis showed that prescriptions that were given at a later time and prescriptions that were given at the index consultation had similar effects. The studies in the patient/public information and education group varied according to their methods of delivery. Since only one or two studies were included for each method, we could not make a definite conclusion on their effectiveness. In general, booklets or pamphlets demonstrated promising effects on antibiotic prescription, if discussed by a practitioner. CONCLUSIONS:Patient-oriented interventions (especially delayed prescriptions) may be effective in reducing antibiotic prescription for URTIs. Further research is needed to investigate the costs and feasibility of implementing these interventions as part of routine clinical practice. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42016048007.

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Understanding determinants of patients' decisions to attend their family physician and to take antibiotics for upper respiratory tract infections: a qualitative descriptive study.

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Understanding determinants of patients' decisions to attend their family physician and to take antibiotics for upper respiratory tract infections: a qualitative descriptive study.

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