Article Figures & Data
Tables
- Table 1.
Importance of Different Reasons for Consulting the Family Physician With a Sore Throat in the Total Population and in the Subgroups of Patients Who Consider Antibiotics Very/Rather Important or Little/Not Important
Total Population (n = 298) Antibiotics Very/Rather Important (n = 106) Antibiotics Little/Not Important (n = 176) Reason for Visit % R % R % R OR (95% CI) P Value* R = ranking order; OR = odds ratio; CI = confidence interval; NA - not applicable. * Difference between the 2 subgroups (antibiotics very/rather important and little/not important); Pearson χ2 test with continuity correction. I want to be examined for the cause of my sore throat 85.5 1 90.5 2 83.0 2 1.95 (0.91–4.18) .117 I want Dr to give me something for the pain 84.5 2 97.1 1 81.8 3 7.56 (2.25–25.35) <.001 I want Dr to explain the likely course of my problem 82.7 3 79.8 4 84.4 1 0.73 (0.39–1.37) .417 I want Dr to explain how serious my problem is 76.4 4 79.0 5 75.0 5 1.26 (0.70–2.25) .529 I want to know how soon I will recover 75.7 5 82.7 3 70.9 6 1.97 (1.08–3.59) .038 I want Dr to explain possible treatments 73.2 6 69.5 6 75.4 4 0.74 (0.43–1.28) .347 I want Dr to talk with me about my sore throat 57.5 7 61.5 7 55.7 7 1.27 (0.77–2.09) .412 I feel anxious and would like Dr’s help 53.2 8 60.2 8 49.7 8 1.53 (0.93–2.51) .117 I want Dr to talk to me about my worries 49.6 9 51.0 10 49.1 9 1.08 (0.66–1.75) .865 I want a note for sick leave for school or work 39.9 10 53.5 9 31.0 10 2.56 (1.54–4.25) <.001 I want an antibiotic 37.6 11 NA NA NA NA NA NA I want to be referred to a specialist 21.2 12 30.0 11 16.6 11 2.16 (1.20–3.87) .014 I have problems and seek support 18.4 13 27.2 12 13.4 12 2.42 (1.30–4.48) .007 - Table 2.
Multivariate Logistic Regression Model With Variables Associated With the Patient’s Hope for Antibiotics, Adjusted for Other Independent Predictors and Potential Confounders
Variable Adjusted OR (95% CI)* P Value OR = odds ratio; CI = confidence interval. * Adjusted for all variables mentioned in the table. I want to be examined for the cause of my sore throat 2.45 (0.81–7.44) .11 I want Dr to give me something for the pain 6.44 (1.16–35.73) .03 I want to know how soon I will recover 1.21 (0.50–2.95) .68 I feel anxious and would like Dr’s help 0.65 (0.28–1.52) .32 I want a note for sick leave for school or work 4.20 (1.82–9.68) .001 I want to be referred to a specialist 4.44 (1.48–13.27) .008 I have problems and seek support 1.03 (0.32–3.27) .96 Patient’s perceived illness severity 1.00 (0.99–1.02) .64 Patient received an antibiotic prescription 4.03 (1.71–9.50) .001 Age of patient 1.01 (0.98–1.04) .34 Male patient 0.60 (0.28–1.29) .19 Educational level of patient 1.01 (0.87–1.16) .91 “Antibiotics speed recovery from sore throat” 3.52 (1.44–8.57) .006
Additional Files
The Article in Brief
Are Sore Throat Patients Who Hope For Antibiotics Actually Asking For Pain Relief?
By Mieke van Driel, MD, MSc, and colleagues
Background Doctors often prescribe antibiotics for patients with sore throats, even though evidence shows that antibiotics may not be effective in such cases. Doctors are more likely to prescribe an antibiotic if they believe the patient expects it. This study examines what sore throat patients consider important when they visit their family doctor.
What This Study Found Pain relief is an important concern of patients visiting their family doctor about a sore throat. Patients who hope to receive an antibiotic prescription are more concerned about pain relief than patients who are not interested in antibiotics.
Implications
- Patients' desire for an antibiotic may be based on the mistaken view that it is the best treatment for pain relief.
- Addressing patients' expectations and needs for managing pain may help doctors treat sore throats without prescribing antibiotics. Additional research is needed to explore this possibility.
Annals Journal Club Selection:
Nov/Dec 2006
The Annals Journal Club is designed to encourage a learning community of those seeking to improve health care and health through enhanced primary care. Additional information is available on the Journal Club home page.
The Annals of Family Medicine encourages readers to develop the learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club, and sharing the results of your discussions in the Annals online discussion for the featured articles. RADICAL is an acronym for: Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. The word radical also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care, and then acting on those discussions.1Articles for Discussion
- van Driel M, De Sutter A, Deveugele M, et al. Are sore throat patients who hope for antibiotics actually asking for pain relief? Ann Fam Med. 2006;4:494-499.
- De Sutter A, Lemiengre MB, Van Maele G, et al. Predicting prognosis and effect of antibiotic treatment in rhinosinusitis. Ann Fam Med. 2006;4:486-493.
- Hickner J. A new look at an old problem: inappropriate antibiotics for acute respiratory infections. Ann Fam Med. 2006;4:484-485.
Discussion Tips
These articles use different methods to address different aspects of the problem of antibiotic overuse for respiratory illness.2 van Driel et al solicit the patient�s perspective on the reason for consulting for acute sore throat. De Sutter et al use clinical data to try to predict illness duration and response to antibiotics in patients with rhinosinusitis. You may wish to discuss only one study, or to consider each separately and then try to draw larger insights across both articles.Discussion Questions
- What is the research question in these studies? Why do the questions matter?
- Are the study designs appropriate for the research questions? How could the designs be improved?
- Study methods�to what degree can the findings be accounted for by:
- How participants were selected?
- How key variables were defined and measured?
- Confounding (false attribution of causality because 2 variables discovered to be associated actually are associated with a third factor)?
- How information was interpreted?
- Chance (as indicated by inferential statistics)?
- Main findings�how do these studies advance current knowledge?
- Generalizability�how transportable are the findings to other settings, particularly to my patients, practice and community? For the DeSutter et al study, how does the nesting of this observational study within an RCT affect its external validity?
- Implications�how can these findings be used to change practice or advance new hypotheses and research? Do you think that searching (in patient care and in research) for subgroups of patients who might benefit from antibiotics is justified? How can patient needs/desires be met without antibiotics?
References
- Stange KC, Miller WL, McLellan LA, et al. Annals journal club: It�s time to get RADICAL. Ann Fam Med. 2006;4:196-197. Available at: http://annfammed.org/cgi/content/full/4/3/196.
- Centers for Disease Control. Antibiotic/Antimicrobial Resistance Clinical Guidelines. March 30, 2006. Available at: http://www.cdc.gov/drugresistance/clinical.htm.
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