Infectious disease/original researchAntibiotic Use for Emergency Department Patients With Upper Respiratory Infections: Prescribing Practices, Patient Expectations, and Patient Satisfaction
Introduction
Increases in antimicrobial resistance, related to antibiotic use and overuse, have been a growing concern.1, 2, 3, 4, 5, 6 Because upper respiratory infections and acute bronchitis are among the most frequent source of antibiotic prescriptions and because antibiotics provide little if any benefit for these conditions, the Centers for Disease Control and Prevention (CDC) and others have published guidelines for appropriate antibiotic use.5, 7, 8, 9, 10, 11 The guidelines have focused on medical appropriateness, but other factors may also affect the decision to prescribe antibiotics.
Physicians may prescribe antibiotics because the patient insists on them or because they believe the patient expects them.12, 13 Patients with upper respiratory infection or bronchitis may insist on antibiotics because they believe that they are necessary for treatment, a perception that could be the result of previous experiences with similar illnesses or the misconception that antibiotics have a beneficial effect in viral illnesses.14, 15, 16 Physicians may believe that patient satisfaction depends on the receipt of an antibiotic prescription, but correction of patient misconceptions may be of value as well.
Previously published studies on antibiotic use in respiratory infections have been predominantly based in primary care settings,13, 14, 16, 17, 18, 19 and so their findings may not necessarily apply to the emergency department (ED). Patients in the ED may be more ill, be less likely to have insurance, and lack access to good medical follow-up.
This study was designed to examine the antibiotic prescribing practices of physicians for ED patients and the effect of those practices on patient satisfaction. Surveys of patients and treating physicians were used to assess some of the clinical and nonclinical factors associated with the decision to prescribe antibiotics, such as patients’ expectations. Other factors contributing to patient satisfaction such as patient education and waiting times were also examined.
Section snippets
Study Design
This was a multicenter, prospective, observational cohort study. Study sites were 10 members of a collaboration of geographically diverse EDs whose participation in the study was supported by the CDC. A detailed description of the structure and administration of the study group has been published previously.20 Patients were interviewed twice during the ED visit and received a telephone follow-up interview 2 weeks later. Treating physicians (residents or attending physicians) were interviewed as
Results
During the study periods, 875 patients were approached for participation in the study. Twenty-one patients were excluded because of incomplete previsit interviews, 107 because of incomplete postvisit interviews, and 17 because of incomplete physician interviews. Patients with asthma (111), pneumonia (85), sinusitis (78), otitis media (48), chronic obstructive pulmonary disease (19), or multiple diagnoses were excluded from further analyses. Patients with other diagnoses necessitating antibiotic
Limitations
We performed simple univariate analyses without performing multivariate adjustments. Because we did not adjust for confounding or interaction, we may have overestimated or underestimated some associations. Some sites used convenience samples, which may have subjected the results to some selection bias. Our study was based in urban, academic EDs so that prescribing practices in other ED settings may differ. We did perform a pilot study of the survey instrument but did not perform any formal
Discussion
Inappropriate antibiotic use by physicians is ubiquitous and has far-reaching consequences. The emergence of drug resistance has been closely linked to antibiotic use.1, 3, 4, 6, 21, 22 The significant incidence of adverse effects in patients given antibiotics inappropriately is also an important consideration.19, 23 Financial considerations are a further concern as more expensive, broad-spectrum agents are used and because overuse may also result in future unnecessary medical visits.14, 24, 25
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2023, Patient Education and CounselingAntibiotic assemblages and their implications for the prevention of antimicrobial resistance
2022, Social Science and MedicineTreatment of Acute Bronchitis and its Impact on Return Emergency Department Visits
2022, Journal of Emergency MedicineCitation Excerpt :However, Pulia et al. studied patients in the ED who received nonindicated antibiotic prescriptions for respiratory tract conditions, including bronchitis, and found no difference in Press Ganey patient satisfaction scores compared with those who do not receive antibiotics (26). Instead, research suggests that patient satisfaction is connected to believing they have a better understanding of their infection, and providing education about acute bronchitis and setting expectations decreased the number of patients who believed that antibiotics are effective against viruses by 43% (20). Education could help avoid prescribing antibiotics that most likely will not benefit and could cause harm to the patient.
Antibiotic expectations of patients attending an emergency department with upper respiratory tract infections: clinical and behavioural determinants of antibiotic use
2022, International Journal of Antimicrobial Agents
Supervising editors: Kathy J. Rinnert, MD, MPH; E. John Gallagher, MD
Author contributions: SO, GJM, MJK, and DAT conceived and designed the study. DAT obtained funding. SO and JN handled data management and statistical analysis. DAT served as group study chair. SO and DJK drafted the article, which was reviewed by all of the authors. SO takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that may create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. The Centers for Disease Control and Prevention Cooperative agreement U50/CCU912342 funded the study.
Available online April 30, 2007.