Rationalisation of antibiotic use in upper respiratory tract infection in primary health care.

The main objective of this research was to investigate patient and prescriber factors that contribute to consulting and prescribing behaviour in the area of suspected upper respiratory tract infection (URTI). Stage 1 Qualitative interviews identified patient and prescriber factors that are important in the decision to consult and prescribe antibiotics respectively in URTI. Five GPs and twelve patients were interviewed. These were tape-recorded, transcribed and systematically analysed. Stage 2 A questionnaire based on the factors identified in the first stage was used to investigate their influence in larger populations of patients with sore throat. This involved recruiting a sample of 275 from a total of 808 (34%) patients prior to the winter period. Patients who reported a sore throat were sent a questionnaire A questionnaire for the GP was also placed in each patient’s notes. This GP questionnaire addressed the prescriber factors identified at stage 1. Ninety-five patients requested questionnaires and 86 (90.5%) returned them. Only a small number (3/11) of GP questionnaires were returned. A different method was used to identify patients when they presented in a general medical practice. Again these patients were asked to fill in a questionnaire. The GP also completed a questionnaire. The findings from both of these methods were similar. Stages 3 and 4 These stages were designed to triangulate and confirm results from stage 1. For stage 3 a questionnaire was sent to all GPs (896) in two health board areas in Scotland. This was returned by 45.5% of GPs and the results were related to individual prescribing data. Factor Analysis was used to identify factors important in the treatment of URTI. Factors were then related to individual GP prescribing data. A significant weak positive correlation was discovered between ‘Total number of prescriptions’ (adjusted for workload) for 3 commonly used antibiotics in URTI and two factors, namely sense of burden / demand (rs=0.169 p<0.001, and the adverse consequences ((rs=0.134 p<0.009). A significant weak negative correlation was present between the factor relating to the patients past experience ((rs=0.197 p<0.0001) of URTI and the prescribing indicator. Stage 4 involved using a novel research technique termed conjoint analysis. This further identified factors which influence patients to consult a GP with URTI and to determine the relative influence of each factor. Logistic regression was used to determine the relative influence of each of the factors. All attributes apart from the treatment obtained were statistically significant and ‘reassurance that it is not serious’ (B= 0.7591, p<0.004) and ‘how long it takes to see a GP’ (B= -0.3095, p<0.0001) were considered to be more important than ‘who decides on the treatment’ (B= -.02972, p< 0.0105) and ‘whether information on sore throat and its treatment is is given by the GP’ (B= 0.2587, p< 0.0576). In conclusion, this research has helped identify and quantify the contribution of factors to the decision of patients to consult with URTI and the decisions of GPs to prescribe antibiotics in URTI. This research adds further weight to existing evidence that it is vitally important to explicitly determine patients’ views and expectations and to address these.

Grantor dc:publisher.institution

Robert Gordon University

Year dc:date.issued

2001

Author dc:creator

• Cunningham, Iain Telfer Scott

Advisor dc:contributor.advisor

• J. Krska, D. McCaig and R.M.E. Richards

• Antibiotics
• Upper respiratory tract infection
• Sore throat
• Prescriptions

Language dc:language

en

Identifier

oai:rgu-repository.worktribe.com:2807347
https://doi.org/10.48526/rgu-wt-2807347

OAI identifier oai:identifier

oai:rgu-repository.worktribe.com:2807347