Antibiotics for coughing in general practice: a questionnaire study to quantify and condense the reasons for prescribing

Abstract

Background: Antibiotics are being overprescribed in ambulant care, especially for respiratory tract infections (RTIs). Gaining insight into the actual reasons for prescribing remains important for the design of effective strategies to optimise antibiotic prescribing. We aimed to determine items of importance for the antibiotic prescribing decision and to make them operational for an intervention trial.

Methods: A postal questionnaire based upon focus group findings was sent to 316 Flemish general practitioners (GPs). On a verbal rating scale the GPs scored to what extent they consider the questionnaire items in decision making in case of suspected RTI in a coughing patient and how strongly the items support or counter antibiotic treatment. Factor analysis was used to condense the data. The relative importance of the yielded operational factors was assessed using Wilcoxon Matched Pairs test.

Results: 59.5% completed the study. Response group characteristics (mean age: 42.8 years; 65.9% men) approximated that of all Flemish GPs. Participants considered all the items included in the questionnaire: always the operational factor 'lung auscultation', often 'whether or not there is something unusual happening' - both medical reasons - and to a lesser extent 'non-medical reasons' (P < 0.001). Non-medical as well as medical reasons support antibiotic treatment, but non-medical reasons to a lesser extent (P < 0.001).

Conclusion: This study quantified, condensed and confirmed the findings of previous focus group research. Practice guidelines and interventions to optimise antibiotic prescribing have to take non-medical reasons into account.

Figure 1

Items from part 1 of the questionnaire (Q1)⁽¹⁾: distribution of scores and factor loadings per yielded factor (1) Part 1 of the questionnaire (Q1) is assessing how strong the questionnaire items argue in favour or against antibiotic treatment in case of suspected RTI in a coughing patient. Only items with factor loading > .40 to the yielded factor are presented. (2) Factor loadings to the yielded factors are presented. Factor 1 (F1) includes all the items relating to the lung auscultation. Factor 2 (F2) includes only items relating to non-medical reasons, either patient or physician related. Factor 3 (F3) includes items determining whether or not there is something unusual happening. (3) The small box represents the median, the larger box the interquartile range, the wiskers the scoring range.

Figure 2

Factors from part 1 of the questionnaire: comparing scores as defined by factor analysis Part 1 of the questionnaire (Q1) is assessing how strong the questionnaire items argue in favour or against antibiotic treatment in case of suspected RTI in a coughing patient. Factor 1 includes all the items relating to the lung auscultation. Factor 2 includes only items relating to non-medical reasons, either patient or physician related. Factor 3 includes items determining whether or not there is something unusual happening. Asterisk means that the factor's score significantly differs from the other factors' scores (p < 0.001)

Figure 3

Items in favour of antibiotic treatment from part 2 of the questionnaire (Q2)⁽¹⁾: distribution of scores and factor loadings per yielded factor (1) Part 2 of the questionnaire (Q2) is assessing how strong the questionnaire items argue in favour or against antibiotic treatment in case of suspected RTI in a coughing patient. Only items that on average argue in favour of antibiotic treatment, with factor loading > .40 to only one of the yielded factors are presented. (2) Factor loadings to the yielded factor are presented. Factor 1 (F1) only includes items relating to medical reasons, either from the lung auscultation or determining whether or not there is something unusual happening, factor 2 only includes items relating to non-medical reasons, either patient or physician related. (3) The small box represents the median, the larger box the interquartile range, the wiskers the scoring range.

Figure 4

Factors from part 2 of the questionnaire: comparing scores as defined by factor analysis Part 2 of the questionnaire (Q2) is assessing how strong the questionnaire items argue in favour or against antibiotic treatment in case of suspected RTI in a coughing patient. Factors 'in favour' include items which according to their mean and sumscore support antibiotic treatment. Factor 1 only includes items relating to medical reasons, either from the lung auscultation or determining whether or not there is something unusual happening, factor 2 only includes items relating to non-medical reasons, either patient or physician related. Factors 'against' include items which according to their mean and sumscore fail to support antibiotic treatment. Factor 1 only includes items expressing no need for antibiotic treatment, either medical or non-medical. Asterisk means that the factor's score significantly differs from the other factors' scores (p < 0.001)

Figure 5

Items against antibiotic treatment from part 2 of the questionnaire (Q2)⁽¹⁾: distribution of scores and factor loadings per yielded factor (1) Part 2 of the questionnaire is assessing how strong the questionnaire items argue in favour or against antibiotic treatment in case of suspected RTI in a coughing patient. Only items that on average argue against antibiotic treatment, with factor loading > .40 to the yielded factor are presented. (2) Factor loadings to the yielded factor are presented. Factor 1 (F1)only includes items expressing no need for antibiotic treatment, either medical or non-medical. (3) The small box represents the median, the larger box the interquartile range, the wiskers the scoring range.