Patient presentation and physician management of upper respiratory tract infections: a retrospective review of over 5 million primary clinic consultations in Hong Kong

Kung, Kenny; Wong, Carmen; Wong, Samuel Yeung Shan; Lam, Augustine; Chan, Christy; Griffiths, Siân; Butler, Christopher Collett

doi:10.1186/1471-2296-15-95

Cited by 18 publications

(35 citation statements)

References 27 publications

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“…20 , 21 In addition, the relatively broad inclusion criteria in our study captured a wide range of patients with cough/LRTI, which may increase the generalisability of our results, while the possible selection and response bias might have underestimated the associations of factors with antibiotics prescription. Studies in the region for upper respiratory tract infections report a decline of antibiotic prescription from 8.1 to 5.1% from 2005 to 2010 in the public primary care sector, 22 which is consistent with our study finding of 6.8% in acute cough in a mixed private and public primary healthcare setting.…”

Section: Discussionsupporting

confidence: 92%

Help-seeking and antibiotic prescribing for acute cough in a Chinese primary care population: a prospective multicentre observational study

Wong

Liu

Butler

et al. 2016

npj Prim Care Resp Med

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Acute cough is a common reason to prescribe antibiotics in primary care. This study aimed to explore help-seeking and antibiotic prescribing for acute cough in Chinese primary care population. This is a prospective multicentre observational study that included adults presenting with acute cough. Clinicians recorded patients’ presenting symptoms, examination findings and medication prescription. Patients completed symptom diaries for up to 28 days by charting their symptom severity and recovery. Adjusted binary logistic regression models identified factors independently associated with antibiotic prescription. Primary care clinicians (n=19) recruited 455 patients. A total of 321 patients (70.5%) returned their completed symptom diaries. Concern about illness severity (41.6%) and obtaining a prescription for symptomatic medications (45.9%), rather than obtaining a prescription for antibiotics, were the main reasons for consulting. Antibiotics were prescribed for 6.8% (n=31) of patients, of which amoxicillin was the most common antimicrobial prescribed (61.3%), as it was associated with clinicians’ perception of benefit from antibiotic treatment (odds ratio (OR): 25.9, 95% confidence interval (CI): 6.7–101.1), patients’ expectation for antibiotics (OR: 5.1, 95% CI: 1.7–11.6), anticipation (OR: 5.1, 95% CI: 1.6–15.0) and request for antibiotics (OR 15.7, 95% CI: 5.0–49.4), as well as the severity of respiratory symptoms (cough, sputum, short of breath and wheeze OR: 2.7–3.7, all P<0.05). There was a significant difference in antibiotic prescription rates between private primary care clinicians and public primary care clinicians (17.4 vs 1.6%, P=0.00). Symptomatic medication was prescribed in 98.0% of patients. Mean recovery was 9 days for cough and 10 days for all symptoms, which was not significantly associated with antibiotic treatment. Although overall antibiotic-prescribing rates were low, there was a higher rate of antibiotic prescribing among private primary care clinicians, which warrants further exploration and scope for education and intervention.

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Section: Discussionsupporting

confidence: 92%

Help-seeking and antibiotic prescribing for acute cough in a Chinese primary care population: a prospective multicentre observational study

Wong

Liu

Butler

et al. 2016

npj Prim Care Resp Med

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“…These infections are very common in the community and more than 50% of the adult population experience ARI symptoms during a 6-month period and one-fifth of them will consult a general practitioner (GP) ( 7 ). As much as 90% of patients diagnosed with acute otitis media, acute sinusitis, or acute tonsillitis are treated with antibiotics in some countries ( 8 , 9 ). In US, the antibiotic prescribing rate for acute bronchitis is about 70% ( 10 ), and in Australia (for GP registrars) about 73% ( 11 ), despite evidence suggesting that the antibiotic prescribing rate for this should be near 0 ( 12 ).…”

Section: Setting the Scenementioning

confidence: 99%

Antibiotic Resistance: What are the Opportunities for Primary Care in Alleviating the Crisis?

Hansen

Hoffmann

McCullough

et al. 2015

Front. Public Health

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Numerous opportunities are available in primary care for alleviating the crisis of increasing antibiotic resistance. Preventing patients from developing an acute respiratory infection (ARI) will obviate any need for antibiotic use downstream. Hygiene measures such as physical barriers and hand hygiene, and possibly vaccination and exercise, may be effective. Also, a large range of complementary and alternative medicines (e.g. zinc, vitamin C and probiotics) are proposed for preventing and treating ARIs, but evidence for efficacy is scarce.General practitioners’ (GPs) attitudes towards antibiotic prescribing are a major factor in the prescribing for ARIs. Professional interventions with educational components are effective, although they have modest effects, and are expensive. GPs’ perceptions – that mistakenly assume as a default that patients want antibiotics for their ARIs – are often wrong. Shared decision making might be a solution, as it enables clinician and patient to participate jointly in making a health decision, having discussed the options together with the evidence for their harms as well as benefits.Furthermore, GPs’ diagnostic uncertainty – often leading to an antibiotic prescription “just in case” – might be addressed by exploiting strategies such as safety-netting, e.g., establishing with the patient a priori clearly defined actions to take if the course of the illness deviates from the expected.None of these strategies or interventions on their own will greatly improve the use of antibiotics for ARIs. However, used in concert, combinations are likely to enable clinicians and health care systems to implement the strategies that will reduce antimicrobial resistance in the future.

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“…Vitamin prescription rate was found to be 38% in the study by Akıcı et al, however in our study it was 3% in compliance with the literature findings. Similarly diverse results have been obtained in various studies concerning frequency of analgesic, and other symptomatic treatment preparations [7, 8, 9, 23]. …”

Section: Discussionmentioning

confidence: 56%

“…In various studies average number of 3.10–3.58 drugs have been written in each prescription. In various studies average number of drugs in each prescription have changed [7, 8, 23]. When prescription rate of combined preparations was taken into consideration, a tendency towards polypharmacy can be expressed.…”

Section: Discussionmentioning

confidence: 99%

Upper respiratory tract infections evaluation of prescriptions

Özdemir

Öztürk

Metiner

et al. 2015

North Clin Istanbul

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OBJECTIVE:We aimed to determine frequency of antibiotic use and retrospectively evaluate prescriptions written for the patients with diagnosis of acute pharyngitis, acute nasopharyngitis and acute tonsillitis by our hospital emergency department physicians in January 2014.METHODS:Records of the patients who were admitted to the education and research hospital between January 1st, 2014 to January 31st 2014 were analyzed in this study. Records of all the patients with the diagnosis of acute nasopharyngitis (J.00), acute pharyngitis (J.02) and acute tonsillitis (J.03) were analyzed, and patients with a second diagnosis or haven’t any prescription were excluded from the study. Frequency of antibiotic and other symptomatic medications use were analyzed in prescriptions of 5261 patients.RESULTS:Antibiotics were prescribed for 63.5% of the patients included in the study, and the most preferred antibiotics were penicilin and beta-lactamase combination (38.8%) and cephalosporins (26.2%). Combined preparations were the most preferred medications in symptomatic treatment (65.9%). Dexketoprofen was the most preferred among nonsteroidal anti-inflammatory drugs (63%). In each prescription, average number of 3.26 drugs were prescribed.CONCLUSION:Excessive and improrer use of antibiotics in the treatment of respiratuary tract infection is a global problem. The use of excess agents in symptomatic medication leads to polypharmacy. Training of physicians and patients on principles of rational drug use will contribute to the solution of this problem.

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Patient presentation and physician management of upper respiratory tract infections: a retrospective review of over 5 million primary clinic consultations in Hong Kong

Cited by 18 publications

References 27 publications

Help-seeking and antibiotic prescribing for acute cough in a Chinese primary care population: a prospective multicentre observational study

Help-seeking and antibiotic prescribing for acute cough in a Chinese primary care population: a prospective multicentre observational study

Antibiotic Resistance: What are the Opportunities for Primary Care in Alleviating the Crisis?

Upper respiratory tract infections evaluation of prescriptions

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