How Do Community Practitioners Decide Whether to Prescribe Antibiotics for Acute Respiratory Tract Infections?

Wigton, Robert S.; Darr, Carol A.; Corbett, Kitty; Nickol, Devin; Gonzales, Ralph

doi:10.1007/s11606-008-0707-9

Cited by 31 publications

(29 citation statements)

References 33 publications

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“…To allow comparison between emergency physicians and community practitioners, we used the same methodology of judgment analysis to study Wisconsin ED physicians as that previously reported for Colorado community practitioners [14]. Judgment analysis models judgment using regression techniques to infer weights of clinical factors in hypothetical clinical vignettes based on subjects' estimates of their likelihood of prescribing antibiotics for each vignette.…”

Section: Methodsmentioning

confidence: 99%

“…We used the same 20 vignettes used in the earlier study of community practitioners' prescribing of antibiotics in ARI [14]. After reading each case, respondents were asked whether or not they would prescribe antibiotics for this patient [yes/no] and how likely it was they would prescribe antibiotics (0 -100 scale).…”

Section: Paper Case Vignettesmentioning

confidence: 99%

“…Previous studies of antibiotic use for respiratory infections have predominantly focused on primary care settings and these findings may not necessarily apply to the ED setting [12]- [14]. In an earlier study using hypothetical case scenarios, primary care practitioners (PCPs) in Colorado prescribed antibiotics for ARI at twice the rate of physicians following CDC practice guidelines.…”

Section: Introductionmentioning

confidence: 99%

“…In an earlier study using hypothetical case scenarios, primary care practitioners (PCPs) in Colorado prescribed antibiotics for ARI at twice the rate of physicians following CDC practice guidelines. The most important factor was duration of illness-circumstantial patient factors were unimportant in deciding whether to prescribe antibiotics [14]. We used these same case scenarios to identify factors that influenced antibiotic prescribing by emergency physicians and compared them to the factors used by PCPs in the earlier study.…”

Section: Introductionmentioning

confidence: 99%

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Factors Affecting Antibiotic Prescribing for Acute Respiratory Infection by Emergency Physicians

Safdar¹,

Tape²,

Fox³

et al. 2014

Health

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Background: Antibiotics are frequently prescribed for upper acute respiratory tract infections (ARI) in the emergency department. To reduce inappropriate overprescribing, it is necessary to understand factors influencing physicians' decisions to prescribe antibiotics. Objective: Analyze the judgment policies of emergency physicians to determine factors predicting antibiotic use. Design: Paper case vignette study. Participants: 104 emergency physicians from Wisconsin. Measurements: We used judgment analysis to derive the policies of 104 emergency physicians from their responses to 20 case vignettes. We designed the cases such that each physician's use of clinical findings and patient factors could be inferred from the decisions they made about each case. Findings were compared to primary care practitioners (PCPs) in Colorado responding to the same paper cases to examine differences in factors influencing prescribing among the two groups. Results: The emergency physicians said they would prescribe an antibiotic (yes/no) in 51.4% of cases compared with 44.5% in the Colorado study. The majority of emergency physicians gave the greatest weight to duration of illness (51%), followed by temperature (20%) and cough (12%). Conclusions: These emergency physicians prescribed antibiotics more frequently than the Colorado PCPs. There was little difference in how clinical findings were weighted, suggesting this was not the source of the higher prescription rate among the emergency physicians. The considerable emphasis on duration of illness suggests that this would be a productive area for educational efforts to reduce antibiotic prescribing for ARI in the emergency department.

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Section: Methodsmentioning

confidence: 99%

Section: Paper Case Vignettesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Factors Affecting Antibiotic Prescribing for Acute Respiratory Infection by Emergency Physicians

Safdar¹,

Tape²,

Fox³

et al. 2014

Health

Self Cite

View full text Add to dashboard Cite

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“…Physicians commonly ask their patients about the colour of their sputum and how unwell they are feeling to inform their decision of whether or not to prescribe an antibiotic for acute cough, based on the assumption that purulence is more likely to reflect a bacterial cause and predict improved outcomes from antibiotics [6][7][8]. Clinicians regard patients who feel both systemically unwell and who also produce discoloured sputum an even higher priority for an antibiotic prescription [9][10][11]. Guidelines identify purulent sputum as one of a cluster of clinical features that should alert clinicians to possible serious lung infection [12].…”

mentioning

confidence: 99%

Antibiotic prescribing for discoloured sputum in acute cough/lower respiratory tract infection

Butler¹,

Kelly²,

Hood³

et al. 2011

Eur Respir J

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We investigated whether discoloured sputum and feeling unwell were associated with antibiotic prescription and benefit from antibiotic treatment for acute cough/lower respiratory tract infection (LTRI) in a prospective study of 3,402 adults in 13 countries.A two-level model investigated the association between producing discoloured sputum or feeling generally unwell and an antibiotic prescription. A three-level model investigated the association between an antibiotic prescription and symptom resolution.Patients producing discoloured sputum were prescribed antibiotics more frequently than those not producing sputum (OR 3.2, 95% CI 2.1-5.0), unlike those producing clear/white sputum (OR 0.95, 95% CI 0.61-1.48). Antibiotic prescription was not associated with a greater rate or magnitude of symptom score resolution (as measured by a 13-item questionnaire completed by patients each day) among those who: produced yellow (coefficient 0.00; p50.68) or green (coefficient -0.01; p50.11) sputum; reported any of three categories of feeling unwell; or produced discoloured sputum and felt generally unwell (coefficient -0.01; p50.19).Adults with acute cough/LRTI presenting in primary care settings with discoloured sputum were prescribed antibiotics more often compared to those not producing sputum. Sputum colour, alone or together with feeling generally unwell, was not associated with recovery or benefit from antibiotic treatment.

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Accounting for variation in and overuse of antibiotics among humans

2021

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Worldwide, antibiotic use is increasing, but many infections against which antibiotics are applied are not even caused by bacteria. Over‐the‐counter and internet sales preclude physician oversight. Regional differences, between and within countries highlight many potential factors influencing antibiotic use. Taking a systems perspective that considers pharmaceutical commodity chains, we examine antibiotic overuse from the vantage point of both sides of the therapeutic relationship. We examine patterns and expectations of practitioners and patients, institutional policies and pressures, the business strategies of pharmaceutical companies and distributors, and cultural drivers of variation. Solutions to improve antibiotic stewardship include practitioners taking greater responsibility for their antibiotic prescribing, increasing the role of caregivers as diagnosticians rather than medicine providers, improving their communication to patients about antibiotic treatment consequences, lessening the economic influences on prescribing, and identifying antibiotic alternatives.

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How Do Community Practitioners Decide Whether to Prescribe Antibiotics for Acute Respiratory Tract Infections?

Cited by 31 publications

References 33 publications

Factors Affecting Antibiotic Prescribing for Acute Respiratory Infection by Emergency Physicians

Factors Affecting Antibiotic Prescribing for Acute Respiratory Infection by Emergency Physicians

Antibiotic prescribing for discoloured sputum in acute cough/lower respiratory tract infection

Accounting for variation in and overuse of antibiotics among humans

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