Patient knowledge of upper respiratory infections: implications for antibiotic expectations and unnecessary utilization

Abstract

Background: Upper respiratory infections (URIs) account for many of the visits in primary care and are commonly treated with ineffective antibiotic therapy. The purpose of this study was to examine patient beliefs in the effectiveness of antibiotics and the likelihood of seeking care for normal presentations of URIs.

Methods: We conducted a survey of 961 adults (> or = 18 years of age) from an undifferentiated patient population in a university-based family practice residency clinic in metropolitan Kentucky, a private internal medicine practice in nonmetropolitan Kentucky, and, in metropolitan Louisiana, an emergency department and a convenience sample from the community.

Results: Seventy-two percent of the sample reported that they would seek care with a condition of 5 days' duration with cough, sore throat, and discolored nasal discharge. Sixty-one percent of the sample expressed their belief that antibiotics are effective for a condition of 5 days' duration with cough, sore throat, and clear nasal discharge; 79% said that they believed antibiotics are effective when there is discolored discharge (P = .0001). Medicaid recipients were most likely to seek care across the symptom complexes. Higher education was related to a decreased belief in the effectiveness of antibiotics for the scenario with clear discharge (P .001), but to an increased belief in the effectiveness of antibiotics in the scenario with discolored discharge (P = .003). The strongest predictor of both likelihood of utilization and belief in effectiveness of antibiotics was usual use of antibiotics for the URI symptom complexes.

Conclusions: Patients lack understanding of the normal presentation of a URI and the effectiveness of antibiotics as a treatment. A confusion about the meaning of discolored nasal discharge is particularly evident, and past antibiotic use may contribute to inappropriate utilization and expectations for antibiotics.