Patient expectation trends on receiving antibiotic prescriptions for respiratory tract infections: A systematic review and meta‐regression analysis

Kianmehr, Hamed; Sabounchi, Nasim S.; Sabounchi, Shabnam Seyedzadeh; Cosler, Leon E.

doi:10.1111/ijcp.13360

Cited by 33 publications

(31 citation statements)

References 74 publications

(140 reference statements)

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“…In addition, these three studies are older compared to other studies and this may in part explain the difference in results. This is consistent with the results of a recent systematic review that showed that the trend of patient expectation for receiving antibiotics for respiratory tract infections is declining over time on a global level [45]. Public knowledge and beliefs may have changed in recent years because of easy access to different sources of information through internet or media.…”

Section: Main Findings Of Study and Comparison With Previous Literaturesupporting

confidence: 90%

Understanding determinants of patients’ decisions to attend their family physician and to take antibiotics for upper respiratory tract infections: a qualitative descriptive study

et al. 2020

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Background: Although antibiotics have little or no benefit for most upper respiratory tract infections (URTIs), they continue to be prescribed frequently in primary care. Physicians perceive that patients' expectations influence their antibiotic prescribing practice; however, not all patients seek antibiotic treatment despite having similar symptoms. In this study, we explored patients' views about URTIs, and the ways patients manage them (including attendance in primary care and taking antibiotics). Methods: Using a qualitative descriptive design, adult English-speaking individuals at a Canadian health center were recruited through convenient sampling. The participants were interviewed using semi-structured interview guide based on the Common Sense-Self-Regulation Model (CS-SRM). The interviews were transcribed verbatim and coded according to CS-SRM dimensions (illness representations, coping strategies). Sampling continued until thematic saturation was achieved. Thematic analysis related to the dimensions of CS-SRM was applied. Results: Generally, participants had accurate perception about the symptoms of URTIs, as well as how to prevent and manage them. However, some participants revealed misconceptions about the causes of URTIs. Almost all participants mentioned that they only visited their doctor if their symptoms got progressively worse and they could no longer self-manage the symptoms. When visiting a doctor, most participants reported that they did not seek antibiotics. They expected to receive an examination and an explanation for their symptoms.

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Section: Main Findings Of Study and Comparison With Previous Literaturesupporting

confidence: 90%

Understanding determinants of patients’ decisions to attend their family physician and to take antibiotics for upper respiratory tract infections: a qualitative descriptive study

et al. 2020

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“…The model explains how patient expectation and provider's PPE during outpatient office visits has changed during the past 23 years. The simulation results for patient expectation to receive antibiotics for ARTI conditions in most age groups and regions, depicted a declining trend during the last two decades, which is confirmed in two other studies …”

Section: Discussionsupporting

confidence: 78%

A system dynamics model of infection risk, expectations, and perceptions on antibiotic prescribing in the United States

Kianmehr

Sabounchi

et al. 2019

Evaluation Clinical Practice

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Rationale, aims, and objectives: Inappropriate antibiotic prescribing is still a major concern that can lead to devastating outcomes including antibiotic resistance. This study aimed to simulate the antibiotic prescribing behaviour by providers for acute respiratory tract infections (ARTIs) and to evaluate the impact of patient expectation, provider's perception of patient's expectation to receive a prescription, and patient's risk for bacterial infection, on the decision to prescribe. Methods:We developed a unique system dynamics (SD) simulation model based on the significant factors that impact the interaction between provider and patient during visits for ARTIs and the decision to prescribe antibiotics. In order to validate the model for different age groups and regions in the United States, we used the sample of 53 000 ARTI patient visits made at outpatient settings between 1993 and 2015, based on the National Ambulatory Medical Care Survey (NAMCS).Results: Simulation results reveal that physician diagnosis for prescribing antibiotics is based on physician's experience from their prior prescribing behaviour, their perception of patient's infection risk, and patient's expectation to receive antibiotics.Also, there are some variations depending on patient's age and residential region. The simulation analysis also depicts the decreasing trend in patient's expectation over the past two decades for most age groups and regions. Conclusions:Given the high number of unnecessary prescriptions for ARTI, we found that policies are needed to influence provider's prescribing behaviour through patient's expectation and provider's perception regarding those expectations. Our simulation framework can further be used by policymakers to design and evaluate interventions that may modify the interaction between health providers and patients to optimize antibiotic prescriptions among ARTI patients for different regions and age groups.

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“…13 There is consistent evidence that GPs are more likely to prescribe antibiotics when their patients are perceived to be expecting them. 8,[14][15][16] A systematic review found a generally positive association between physician perceptions of patient expectation and antibiotic prescription, 17 but some studies find evidence of a negative association between expectation and prescription 4 with evidence of inconsistency between physicians' perceptions and patients' desire for antibiotics. It is also well established that prescribing antibiotics increases the likelihood that patients will consult in future illness episodes, 18 raising the possibility that expectations are a consequence not a cause of antibiotic prescribing.…”

Section: Backg Rou N Dmentioning

confidence: 99%

Revisiting patient expectations and experiences of antibiotics in an era of antimicrobial resistance: Qualitative study

Boiko

Gulliford

Burgess

2020

Health Expectations

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Objective To investigate contemporary patient expectations and experiences of antibiotic prescribing in England. Background Primary care providers’ compliance with patient influences has been identified as a motivation for antibiotic‐prescribing behaviour. Since 2013, there have been concerted efforts to publicize and address the growing threat of antimicrobial resistance. A fresh qualitative insight into patient expectations and experiences is needed. Design Qualitative study using semi‐structured interviews. Setting and participants Two English regions, one an urban metropolitan area and the other a town in rural England. Patients who recently consulted for infections were recruited. The information power approach was used to determine the number of participants, yielding a sample of 31 participants. Main measures Thematic analysis was carried out to analyse the interview data. Results Five themes were identified: beliefs, expectations, experiences of taking antibiotic, experience of antimicrobial resistance and side‐effects, and experiences of consultations. The accounts reflected improved public knowledge: antibiotics were perceived to be much‐needed medicines that should be prescribed when appropriate. The data showed that patients formed expectations of expectations, trying to read the prescribers’ intentions and reflect on the dependency between what prescribers and patients wanted. Patient experiences featured as nuanced and detailed with knowledge of AMR and side‐effects of antibiotics in the context of positive consultation experiences. Conclusions The study highlighted complex interplays between adherence to antibiotics and consuming antibiotics in reflexive, informed ways. Ensuring that present and future patients are informed about potential benefits and harms of antibiotic use will contribute to future antimicrobial stewardship.

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Patient expectation trends on receiving antibiotic prescriptions for respiratory tract infections: A systematic review and meta‐regression analysis

Cited by 33 publications

References 74 publications

Understanding determinants of patients’ decisions to attend their family physician and to take antibiotics for upper respiratory tract infections: a qualitative descriptive study

Understanding determinants of patients’ decisions to attend their family physician and to take antibiotics for upper respiratory tract infections: a qualitative descriptive study

A system dynamics model of infection risk, expectations, and perceptions on antibiotic prescribing in the United States

Revisiting patient expectations and experiences of antibiotics in an era of antimicrobial resistance: Qualitative study

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