Are Patient Views about Antibiotics Related to Clinician Perceptions, Management and Outcome? A Multi-Country Study in Outpatients with Acute Cough
Permanent lenke
https://hdl.handle.net/10037/6012Dato
2013Type
Journal articleTidsskriftartikkel
Peer reviewed
Forfatter
Coenen, Samuel; Francis, Nick; Kelly, Mark; Hood, Kerenza; Nuttal, Jacqui; Little, Paul; Verheij, Theo J. M.; Melbye, Hasse; Goossens, Herman; Butler, Christopher C.Sammendrag
Background: Outpatients with acute cough who expect, hope for or ask for antibiotics may be more unwell, benefit more
from antibiotic treatment, and be more satisfied with care when they are prescribed antibiotics. Clinicians may not
accurately identify those patients.
Objective: To explore whether patient views (expecting, hoping for or asking for antibiotics) are associated with illness
presentation and resolution, whether patient views are accurately perceived by clinicians, and the association of all these
factors with antibiotic prescribing and patient satisfaction with care.
Methods: Prospective observational study of 3402 adult patients with acute cough presenting in 14 primary care networks.
Correlations and associations tested with multilevel logistic regression and McNemar ‘s tests, and Cohen’s Kappa, positive
agreement (PA) and negative agreement (NA) calculated as appropriate.
Results: 1,213 (45.1%) patients expected, 1,093 (40.6%) hoped for, and 275 (10.2%) asked for antibiotics. Clinicians perceived
840 (31.3%) as wanting to be prescribed antibiotics (McNemar’s test, p,0.05). Their perception agreed modestly with the
three patient views (Kappa’s = 0.29, 0.32 and 0.21, PA’s = 0.56, 0.56 and 0.33, NA’s = 0.72, 0.75 and 0.82, respectively). 1,464
(54.4%) patients were prescribed antibiotics. Illness presentation and resolution were similar for patients regardless their
views. These associations were not modified by antibiotic treatment. Patient expectation and hope (OR:2.08, 95%
CI:[1.48,2.93] and 2.48 [1.73,3.55], respectively), and clinician perception (12.18 [8.31,17.84]) were associated with antibiotic
prescribing. 2,354 (92.6%) patients were satisfied. Only those hoping for antibiotics were less satisfied when antibiotics were
not prescribed (0.39 [0.17,0.90]).
Conclusion: Patient views about antibiotic treatment were not useful for identifying those who will benefit from antibiotics.
Clinician perceptions did not match with patient views, but particularly influenced antibiotic prescribing. Patients were
generally satisfied with care, but those hoping for but not prescribed antibiotics were less satisfied. Clinicians need to more
effectively elicit and address patient views about antibiotics.
Forlag
Public Library of Science (PLoS)Sitering
PLoS ONE (2013), vol. 8(10): e76691.Metadata
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