Reducing Expectations for Antibiotics in Patients With Upper Respiratory Tract Infections: A Primary Care Randomized Controlled Trial

Abstract

Purpose: Many family practitioners prescribe antibiotics for patients with upper respiratory tract infections (URTIs) to meet patients' expectations. We evaluated the impact of providing brief tablet-based information about antibiotic treatment of URTIs on patients' expectations for antibiotics and on family practitioners' antibiotic-prescribing behavior.

Methods: We performed a 3-arm randomized controlled trial among patients presenting with URTIs at 2 urban family practices in Auckland, New Zealand, during winter 2018. Participants were randomly allocated to view a presentation about the futility of antibiotic treatment of URTIs, the adverse effects associated with antibiotics, or the benefits of healthy diet and exercise (active control), immediately before their consultation. Before and after viewing the presentations, participants used a Likert scale to rate the strength of their belief that antibiotics are effective for treating URTIs and of their desire to be prescribed an antibiotic. Patients reported whether an antibiotic had been prescribed, and pharmacy dispensing records were reviewed to determine whether an antibiotic was dispensed.

Results: Participants who viewed either the futility or the adverse effects presentation had greater reductions in their expectations to receive antibiotics than the control group. The mean reduction (95% CI) was 1.1 (0.8-1.3) for the futility group, 0.7 (0.4-0.9) for the adverse effects group, and 0.1 (0-0.3) for the control group (Cohen d = 0.7; P <.001). There was no significant difference among the 3 groups with regard to antibiotic prescribing (P = .84) or dispensing (P = .43).

Conclusions: A brief tablet-based waiting room intervention significantly reduced participants' expectations about receiving antibiotics for URTI immediately before their family practitioner consultation. The intervention did not influence family practitioner prescribing behavior, however.

Keywords: antibiotic prescriptions; antimicrobial stewardship education; family practice; patient expectations; physician-patient communication; practice-based research; primary health care; respiratory tract infections.

Figure 1.

CONSORT diagram showing participant flow through the study. CONSORT = Consolidated Standards of Reporting Trials. ^a A total of 19 participants were lost to follow-up at postconsultation (N = 306 were followed up). ^b An additional 2 participants did not have data available for analysis (N = 304 had complete data for analysis).

Figure 2.

Participants’ expectation of receiving an antibiotic. Notes: Participants used a 7-point Likert scale to express level of agreement with the statement, “I wish to receive antibiotics for my/my child’s cold/flu.” For graphical purposes, the Likert scores were collapsed to a 5-point scale by combining responses of 1 and 2 to represent “strongly disagree” and 6 and 7 to represent “strongly agree.” Values in circles are means.