August 11, 2022

Intervention in the waiting room reduces patient expectations for antibiotics

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An intervention that was given just before patients visited their family doctors significantly lowered their expectations of receiving antibiotics for an upper respiratory infection, according to trial data.

However, the intervention did not change the prescribing habits of family physicians, the researchers reported.

“Clinicians and patients play an important role in reducing inappropriate prescriptions for antibiotics, but we need effective and scalable interventions to help us do so.” Anne Ishani Perera, MBChB, from the Department of Psychological Medicine at the University of Auckland in New Zealand, told Healio Primary Care.

Providers are often pressured by patients to prescribe antibiotics, which Perera says is a factor in inappropriate prescribing.

The researchers asked 325 patients (median age, 39 years; 69% female) who presented to one of two family medicine clinics in New Zealand with the flu or a cold to complete a questionnaire on the seven-point Likert scale. Patients were asked about the severity of their illness – or in some cases, parents were asked about their child’s illness – as well as their attitudes towards antibiotics to treat upper respiratory infections and their expectations to receive them. .

Patients were randomly assigned to watch one of three slide presentations on a tablet: the first discussed the uselessness of antibiotics for upper respiratory tract infections and provided information on alternative treatments; the second dealt with possible adverse events associated with the use of antibiotics and provided information on alternative treatments; and the third (control) encouraged healthy lifestyle choices and did not mention antibiotics or upper respiratory tract infections. As soon as the video ended, patients were asked about their level of agreement with the following statements: “I think antibiotics are a useful treatment for colds / flu” and “I would like to receive antibiotics for colds. / my / child’s common cold / flu. “The patient (and, if applicable, his / her child) then went to the family doctor. Although the clinicians were aware of the trial, they were not sure which patients had participated in the trial. the intervention or what slide presentations the patients had seen.

“The two family practices involved in our study had low levels of antibiotic prescribing compared to other practices in New Zealand, essentially giving the intervention less power to reduce the prescription of antibiotics to a statistically significant level, ”Perera said in the interview.

Researchers reported that patients who watched the presentation on the uselessness of antibiotics for upper respiratory tract infections or the presentation on adverse events significantly reduced expectations of receiving antibiotics (mean reduction = 1.1 [95% CI, 0.8-1.3] and 0.7 [95% CI, 0.4-0.9], respectively) compared to the control group (mean reduction = 0.1 [95% CI, 0-0.3]).

There was no significant difference between the three cohorts in the behavior of prescribing or dispensing antibiotics by physicians.

Perera hypothesized that if the intervention were used in other practices with higher prescription rates, it “would be able to significantly reduce the prescription of antibiotics.” However, the study lacked the power to determine why the intervention failed to reduce antibiotic prescriptions. She mentioned a larger trial slated for 2022 that will focus on doctor-patient consultation across a “more diverse range of family practices” and seek to positively influence doctors’ antibiotic prescribing behaviors.