Article Figures & Data
Figures
- Figure 1.
CONSORT diagram showing participant flow through the study.
CONSORT = Consolidated Standards of Reporting Trials.
a A total of 19 participants were lost to follow-up at postconsultation (N = 306 were followed up).
b An additional 2 participants did not have data available for analysis (N = 304 had complete data for analysis).
- Figure 2.
Participants’ expectation of receiving an antibiotic.
Notes: Participants used a 7-point Likert scale to express level of agreement with the statement, “I wish to receive antibiotics for my/my child’s cold/flu.” For graphical purposes, the Likert scores were collapsed to a 5-point scale by combining responses of 1 and 2 to represent “strongly disagree” and 6 and 7 to represent “strongly agree.” Values in circles are means.
Tables
Characteristic Futility Group (n = 119) Adverse Effects Group (n = 104) Control Group (n = 102) Total (N = 325) Age, median (IQR), y 36 (28-56) 42 (32-56) 40 (29-58) 39 (31-49) Sex, No. (%) Male 38 (32) 30 (29) 33 (32) 101 (31) Female 81 (68) 74 (71) 69 (68) 224 (69) Ethnicity, No. (%) New Zealand European 92 (77) 94 (90) 87 (85) 273 (84) Asian 17 (14) 8 (8) 6 (6) 31 (10) Pacific 5 (4) 2 (2) 4 (4) 11 (3) Māori 5 (5) 0 5 (5) 10 (3) Highest education level,a No. (%) School 16 (14) 22 (21) 15 (15) 53 (16) Trade/other 18 (15) 21 (20) 19 (19) 58 (18) University 83 (71) 60 (58) 68 (67) 211 (65) Predominant symptoms,b No. (%) Cough 85 (71) 77 (74) 78 (77) 240 (74) Sore throat 64 (54) 50 (48) 51 (50) 165 (51) Nasal 68 (57) 56 (54) 61 (60) 185 (57) Earache 29 (24) 28 (27) 22 (22) 79 (24) Child (aged 0-7 years), No. (%) 34 (29) 26 (25) 31 (30) 91 (28) Antibiotic prescription received,c No. (%) 34 (31) 28 (29) 31 (32) 93 (30) Antibiotic dispensed,d No. (%) 34 (31) 22 (22) 28 (29) 84 (28) IQR = interquartile range.
Note: Distribution of participants: 37% in futility group, 32% in adverse effects group, and 31% in control group.
↵a Three participants did not answer this question.
↵b Participants were asked to select all symptoms that applied.
↵c A total of 306 participants answered this question.
↵d A total of 304 participants had this information available.
Characteristic Proportion Expecting Antibiotics, %a aOR (95% CI) P Value Group Control 39 Ref … Futility 40 0.58 (0.35-0.95) .03 Adverse effects 39 0.44 (0.26-0.74) <.01 Sex Female 36 Ref … Male 48 1.75 (1.12-2.74) .02 Age-group Adult 40 Ref … Childb 39 0.72 (0.44-1.18) .19 Predominant symptoms Sore throat No 39 Ref … Yes 39 1.62 (1.06-2.48) .03 Cough No 33 Ref … Yes 42 1.30 (0.81-2.11) .28 Earache No 38 Ref … Yes 44 1.28 (0.79-2.09) .32 Symptom severityc … 1.16 (0.91-1.47) .22 Degree of concernc … 1.15 (0.96-1.37) .13 aOR = adjusted odds ratio; Ref = reference.
Note: Assessed after participants viewed 1 of the presentations, with the postpresentation questionnaire.
↵a Unadjusted.
↵b Parents provided response for children aged 0 to 7 years presenting with symptoms of upper respiratory tract infection.
↵c Measured on a 7-point scale where higher score indicates greater severity or concern.
- Table 3.
Adjusted Odd Ratios of Receiving an Antibiotic Prescription and Having an Antibiotic Dispensed
Characteristic Antibiotic Prescription Received Antibiotic Dispensed Unadjusted Proportion, % aOR (95% CI) P Value Unadjusted Proportion, % aOR (95% CI) P Value Group Control 31 Ref … 32 Ref … Futility 30 0.86 (0.46-1.61) .60 27 1.09 (0.56-2.09) .80 Adverse effects 31 0.83 (0.43-1.59) .60 24 0.73 (0.36-1.47) .40 Age in years … 1.02 (1.00-1.04) .10 … 1.01 (0.99-1.03) .40 Symptom severity … 1.26 (0.95-1.66) .10 … 1.49 (1.12-2.00) .01 Predominant symptoms Cough No 28 Ref … 29 Ref … Yes 31 0.94 (0.50-1.76) .80 27 0.72 (0.38-1.38) .30 Sore throat No 31 Ref … 28 Ref … Yes 30 0.59 (0.34-1.04) .07 27 0.57 (0.31-1.04) .07 Nasal No 29 Ref … 24 Ref … Yes 32 0.96 (0.54-1.71) .90 31 1.20 (0.66-2.20) .60 Earache No 27 Ref … 25 Ref … Yes 42 2.36 (1.30-4.30) <.01 36 1.80 (0.96-3.41) .07 Age-group Adult 30 Ref … 28 Ref … Child 31 1.25 (0.68-2.29) .50 26 1.16 (0.62-2.19) .70 Expect antibioticsa Neutral 34 Ref … 27 Ref … Strongly disagree 17 0.71 (0.35-1.45) .30 11 2.01 (0.91-4.44) .08 Disagree 25 0.90 (0.34-2.37) .80 25 1.61 (0.56-4.64) .40 Agree 30 1.08 (0.46-2.54) .90 22 2.05 (0.78-5.35) .10 Strongly agree 56 2.69 (1.27-5.69) .01 58 6.76 (2.92-15.67) <.01 aOR = adjusted odds ratio; Ref = reference.
Notes: Binomial logistic regression analyses, based on 306 participants for an antibiotic prescription received and 304 participants for an antibiotic dispensed.
↵a Based on response on postpresentation questionnaire. Responses on the 7-point Likert scale were collapsed to a 5-point scale by combining responses of 1 and 2 to represent “strongly disagree” and 6 and 7 to represent “strongly agree.”
Supplemental tables
Supplemental tables
- Supplemental data -
PDF file
- Supplemental data -
The Article in Brief
Reducing Expectations for Antibiotics in Patients With Upper Respiratory Tract Infections: A Primary Care Randomized Controlled Trial
Anna Ishani Perera, and colleagues
Background Inappropriate antibiotic prescribing for upper respiratory tract infections contributes to antibiotic resistance, making some bacterial infections difficult to treat. This often leads to higher medical costs, prolonged hospital stays and increased mortality. Still, many physicians report prescribing antibiotics at their patients’ request. To address patients’ expectations for antibiotic prescribing for URTIs, researchers conducted an experiment in which study participants were assigned brief educational videos to watch on a tablet immediately prior to their appointment.
What This Study Found The authors randomized patients into three groups – one that viewed a presentation about the futility of antibiotic treatment of URTIs; a second group that viewed a presentation about the adverse effects associated with antibiotics; and a third control group that learned about the benefits of healthy diet/exercise.The researchers then measured the effects of the presentations on patients’ beliefs that antibiotics are helpful for URTIs; their expectations to be prescribed an antibiotic; and whether they were actually prescribed antibiotics for their URTIs. Participants who viewed either the futility or adverse effects presentations had greater reductions in their expectations of receiving antibiotics compared to the group that viewed the video about the benefits of healthy/diet and exercise. However, there was no significant difference between the three groups when it came to doctors actually prescribing antibiotics to patients.
Implications
- A brief, tablet-based waiting room intervention significantly changes participants’ expectations on receiving antibiotics for URTIs, but that future efforts to improve antibiotic prescribing need to involve both patients and their doctors.
