Patient-targeted education has limited effect on antibiotic prescribing habits
Educating patients on the outcomes of inappropriate antibiotic use has a limited effect in reducing their likelihood of receiving an antibiotic prescription, a local study found.
Study subjects were 914 patients (median age, 35 years, 48.8 percent male) presenting at 24 private general practitioner (GP) clinics in Singapore with upper respiratory tract infection (URTI) symptoms. Researchers randomized the patients to two groups (n=457 each); patients in the intervention group were educated on URTI aetiology, the role of antibiotics in URTI treatment, and the consequences of inappropriate antibiotic use, while patients in the control group were educated on influenza and influenza vaccinations. Education was provided just prior to the patient’s consultation with the GP.
The number of antibiotics prescribed did not significantly differ between the intervention and control groups (20.6 percent vs 17.7 percent, odds ratio [OR], 1.20, 95 percent confidence interval [CI], 0.83–1.73; p=0.322) with one exception; patients of Indian ethnicity in the intervention group received fewer antibiotic prescriptions (OR, 0.27, 95 percent CI, 0.08–0.97; p=0.044). [Antimicrob Agents Chemother 2017;doi:10.1128/AAC.02257-16]
There was an overall association between intervention and improvement in patient’s understanding of URTI aetiology (p<0.001). However, concern about antibiotic side effects (p=0.014) and knowledge that antibiotics are mostly unnecessary for URTIs (p=0.048) pertained only to patients of Indian ethnicity.
Patients aged ≥65 years had the highest likelihood of receiving an antibiotic compared with those aged 21–34 years (OR, 3.71, 95 percent CI, 1.42–9.72; p=0.008). Patients who wanted antibiotics were also more likely to receive them (OR, 3.16, 95 percent CI, 2.04–4.89; p<0.001).
A large variation in the number of prescriptions across the GPs (0–70 percent) in this study led the researchers to recommend that future studies involve measures that target GPs. “[This] suggests that GP factors such as clinical judgment and prescribing habits, and healthcare system factors such as health policies were more critical in determining whether an antibiotic was prescribed than what could be achieved through our patient-targeted intervention,” they said.
The researchers acknowledged that the small number of GPs and the variation in numbers of patients per GP were among the study limitations, as was the short time frame for education prior to GP consultation.
“It has been postulated that patients undergo a complex process of behavioural change ... with time needed for an educational intervention to demonstrate its effects. If so, prescriptions at subsequent consultations might be more suitable in assessing the efficacy of such interventions than our current study design which focused on prescriptions in the same visit,” said the researchers, on one potential reason for the nonreduction in prescriptions postintervention.