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Are patient views about antibiotics related to clinician perceptions, management and outcome? A multi-country study in outpatients with acute cough

Are patient views about antibiotics related to clinician perceptions, management and outcome? A multi-country study in outpatients with acute cough
Are patient views about antibiotics related to clinician perceptions, management and outcome? A multi-country study in outpatients with acute cough
Background: outpatients with acute cough who expect, hope for or ask for antibiotics may be more unwell, benefit more from antibiotic treatment, and be more satisfied with care when they are prescribed antibiotics. Clinicians may not accurately identify those patients.

Objective: to explore whether patient views (expecting, hoping for or asking for antibiotics) are associated with illness presentation and resolution, whether patient views are accurately perceived by clinicians, and the association of all these factors with antibiotic prescribing and patient satisfaction with care.

Methods: prospective observational study of 3402 adult patients with acute cough presenting in 14 primary care networks. Correlations and associations tested with multilevel logistic regression and McNemar ‘s tests, and Cohen’s Kappa, positive agreement (PA) and negative agreement (NA) calculated as appropriate.

Results: 1,213 (45.1%) patients expected, 1,093 (40.6%) hoped for, and 275 (10.2%) asked for antibiotics. Clinicians perceived 840 (31.3%) as wanting to be prescribed antibiotics (McNemar’s test, p<0.05). Their perception agreed modestly with the three patient views (Kappa’s = 0.29, 0.32 and 0.21, PA’s = 0.56, 0.56 and 0.33, NA’s = 0.72, 0.75 and 0.82, respectively). 1,464 (54.4%) patients were prescribed antibiotics. Illness presentation and resolution were similar for patients regardless their views. These associations were not modified by antibiotic treatment. Patient expectation and hope (OR:2.08, 95% CI:[1.48,2.93] and 2.48 [1.73,3.55], respectively), and clinician perception (12.18 [8.31,17.84]) were associated with antibiotic prescribing. 2,354 (92.6%) patients were satisfied. Only those hoping for antibiotics were less satisfied when antibiotics were not prescribed (0.39 [0.17,0.90]).

Conclusion: patient views about antibiotic treatment were not useful for identifying those who will benefit from antibiotics. Clinician perceptions did not match with patient views, but particularly influenced antibiotic prescribing. Patients were generally satisfied with care, but those hoping for but not prescribed antibiotics were less satisfied. Clinicians need to more effectively elicit and address patient views about antibiotics
1932-6203
e:76691
Coenen, S.
9afe2a52-9f4f-45bb-b8e5-c6ee3eeb3498
Francis, N.
7e3c0c61-da54-491a-bca9-bc9ddc4f9f12
Kelly, M.
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Hood, K.
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Nuttall, J.
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Little, P.
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Verheij, T.J.
809e3576-51ad-48e2-9762-e5d1ab873728
Melbye, H.
0af8f977-61f5-414a-82ba-8843eb63df77
Goossens, H.
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Butler, C.C.
736f78ad-3e18-4c63-900f-c2249577b645
Coenen, S.
9afe2a52-9f4f-45bb-b8e5-c6ee3eeb3498
Francis, N.
7e3c0c61-da54-491a-bca9-bc9ddc4f9f12
Kelly, M.
5b6e232c-a25d-4ac1-b91c-5f571997ccaf
Hood, K.
12e14eb3-2c75-409f-a69d-add733644d89
Nuttall, J.
b5ae8614-d0fa-4488-80f6-33593bb48129
Little, P.
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Verheij, T.J.
809e3576-51ad-48e2-9762-e5d1ab873728
Melbye, H.
0af8f977-61f5-414a-82ba-8843eb63df77
Goossens, H.
533640f7-b568-4d95-a7c1-28158d154ba8
Butler, C.C.
736f78ad-3e18-4c63-900f-c2249577b645

Coenen, S., Francis, N., Kelly, M., Hood, K., Nuttall, J., Little, P., Verheij, T.J., Melbye, H., Goossens, H. and Butler, C.C. (2013) Are patient views about antibiotics related to clinician perceptions, management and outcome? A multi-country study in outpatients with acute cough. PLoS ONE, 8 (10), e:76691. (doi:10.1371/journal.pone.0076691).

Record type: Article

Abstract

Background: outpatients with acute cough who expect, hope for or ask for antibiotics may be more unwell, benefit more from antibiotic treatment, and be more satisfied with care when they are prescribed antibiotics. Clinicians may not accurately identify those patients.

Objective: to explore whether patient views (expecting, hoping for or asking for antibiotics) are associated with illness presentation and resolution, whether patient views are accurately perceived by clinicians, and the association of all these factors with antibiotic prescribing and patient satisfaction with care.

Methods: prospective observational study of 3402 adult patients with acute cough presenting in 14 primary care networks. Correlations and associations tested with multilevel logistic regression and McNemar ‘s tests, and Cohen’s Kappa, positive agreement (PA) and negative agreement (NA) calculated as appropriate.

Results: 1,213 (45.1%) patients expected, 1,093 (40.6%) hoped for, and 275 (10.2%) asked for antibiotics. Clinicians perceived 840 (31.3%) as wanting to be prescribed antibiotics (McNemar’s test, p<0.05). Their perception agreed modestly with the three patient views (Kappa’s = 0.29, 0.32 and 0.21, PA’s = 0.56, 0.56 and 0.33, NA’s = 0.72, 0.75 and 0.82, respectively). 1,464 (54.4%) patients were prescribed antibiotics. Illness presentation and resolution were similar for patients regardless their views. These associations were not modified by antibiotic treatment. Patient expectation and hope (OR:2.08, 95% CI:[1.48,2.93] and 2.48 [1.73,3.55], respectively), and clinician perception (12.18 [8.31,17.84]) were associated with antibiotic prescribing. 2,354 (92.6%) patients were satisfied. Only those hoping for antibiotics were less satisfied when antibiotics were not prescribed (0.39 [0.17,0.90]).

Conclusion: patient views about antibiotic treatment were not useful for identifying those who will benefit from antibiotics. Clinician perceptions did not match with patient views, but particularly influenced antibiotic prescribing. Patients were generally satisfied with care, but those hoping for but not prescribed antibiotics were less satisfied. Clinicians need to more effectively elicit and address patient views about antibiotics

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Published date: 2013
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 365983
URI: https://eprints.soton.ac.uk/id/eprint/365983
ISSN: 1932-6203
PURE UUID: 3762ff76-40f5-4486-b479-5c9b6c46d709

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Date deposited: 20 Jun 2014 09:03
Last modified: 11 Nov 2019 20:51

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