Julie Domen, Rune Aabenhus, Anca Balan, Emily Bongard, Femke Böhmer, Valerija Bralić Lang, Pascale Bruno, Slawomir Chlabicz, Annelies Colliers, Ana García-Sangenís, Hrachuhi Ghazaryan, Anna Kowalczyk, Siri Jensen, Christos Lionis, Tycho M van der Linde, Lile Malania, Jozsef Pauer, Angela Tomacinschii, Akke Vellinga, Ihor Zastavnyy, Herman Goossens, Christopher C Butler, Alike W van der Velden, Samuel Coenen
{"title":"全科医生对患者抗生素请求的看法对呼吸道感染抗生素处方的影响:对18个欧洲国家的点患病率审计调查的二次分析。","authors":"Julie Domen, Rune Aabenhus, Anca Balan, Emily Bongard, Femke Böhmer, Valerija Bralić Lang, Pascale Bruno, Slawomir Chlabicz, Annelies Colliers, Ana García-Sangenís, Hrachuhi Ghazaryan, Anna Kowalczyk, Siri Jensen, Christos Lionis, Tycho M van der Linde, Lile Malania, Jozsef Pauer, Angela Tomacinschii, Akke Vellinga, Ihor Zastavnyy, Herman Goossens, Christopher C Butler, Alike W van der Velden, Samuel Coenen","doi":"10.3399/BJGPO.2024.0166","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Illness severity, comorbidity, fever, age, and symptom duration influence antibiotic prescribing for respiratory tract infections (RTI). Non-medical determinants, such as patient expectations, also impact prescribing.</p><p><strong>Aim: </strong>To quantify the effect of a GP's perception of a patient request for antibiotics on antibiotic prescribing for RTI and investigate effect modification by medical determinants and country.</p><p><strong>Design & setting: </strong>Prospective audit of general practices in 18 European countries.</p><p><strong>Method: </strong>Consultation data were registered of 4982 patients presenting with acute cough and/or sore throat. A mixed-effect logistic regression model analysed the effect of GPs' perceptions of a patient request for antibiotics. Two-way interaction terms assessed effect modification. Relevant clinical findings were added to subgroups of lower RTI (LRTI), throat infection, and influenza-like-illness (ILI).</p><p><strong>Results: </strong>A GP's perception of a request for antibiotics meant they were four times more likely to prescribe antibiotics (odds ratio [OR] 4.4, 95% confidence interval [CI] = 3.4 to 5.5). This effect varied by country: lower in Spain (OR 0.06), Ukraine (OR 0.15), and Greece (OR 0.22) compared with the lowest prescribing country. The effect was higher for ILI (OR 13.86, 95% CI = 5.5 to 35) and throat infection (OR 5.1, 95% CI = 3.1 to 8.4) than for LRTI (OR 2.9, 95% CI = 1.9 to 4.3). For ILI and LRTI, GPs were more likely to prescribe antibiotics with abnormal lung auscultation and/or increased or purulent sputum and for throat infection, with tonsillar exudate and/or swollen tonsils.</p><p><strong>Conclusion: </strong>GPs' perceptions of an antibiotic request and specific clinical findings influence antibiotic prescribing. Incorporating exploration of patient expectations, point-of-care testing, and discussing watchful waiting into the decision-making process will benefit appropriate prescribing of antibiotics.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5000,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The effect of a GP's perception of a patient request for antibiotics on antibiotic prescribing for respiratory tract infections: secondary analysis of a point-prevalence audit survey in 18 European countries.\",\"authors\":\"Julie Domen, Rune Aabenhus, Anca Balan, Emily Bongard, Femke Böhmer, Valerija Bralić Lang, Pascale Bruno, Slawomir Chlabicz, Annelies Colliers, Ana García-Sangenís, Hrachuhi Ghazaryan, Anna Kowalczyk, Siri Jensen, Christos Lionis, Tycho M van der Linde, Lile Malania, Jozsef Pauer, Angela Tomacinschii, Akke Vellinga, Ihor Zastavnyy, Herman Goossens, Christopher C Butler, Alike W van der Velden, Samuel Coenen\",\"doi\":\"10.3399/BJGPO.2024.0166\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Illness severity, comorbidity, fever, age, and symptom duration influence antibiotic prescribing for respiratory tract infections (RTI). Non-medical determinants, such as patient expectations, also impact prescribing.</p><p><strong>Aim: </strong>To quantify the effect of a GP's perception of a patient request for antibiotics on antibiotic prescribing for RTI and investigate effect modification by medical determinants and country.</p><p><strong>Design & setting: </strong>Prospective audit of general practices in 18 European countries.</p><p><strong>Method: </strong>Consultation data were registered of 4982 patients presenting with acute cough and/or sore throat. A mixed-effect logistic regression model analysed the effect of GPs' perceptions of a patient request for antibiotics. Two-way interaction terms assessed effect modification. Relevant clinical findings were added to subgroups of lower RTI (LRTI), throat infection, and influenza-like-illness (ILI).</p><p><strong>Results: </strong>A GP's perception of a request for antibiotics meant they were four times more likely to prescribe antibiotics (odds ratio [OR] 4.4, 95% confidence interval [CI] = 3.4 to 5.5). This effect varied by country: lower in Spain (OR 0.06), Ukraine (OR 0.15), and Greece (OR 0.22) compared with the lowest prescribing country. The effect was higher for ILI (OR 13.86, 95% CI = 5.5 to 35) and throat infection (OR 5.1, 95% CI = 3.1 to 8.4) than for LRTI (OR 2.9, 95% CI = 1.9 to 4.3). For ILI and LRTI, GPs were more likely to prescribe antibiotics with abnormal lung auscultation and/or increased or purulent sputum and for throat infection, with tonsillar exudate and/or swollen tonsils.</p><p><strong>Conclusion: </strong>GPs' perceptions of an antibiotic request and specific clinical findings influence antibiotic prescribing. Incorporating exploration of patient expectations, point-of-care testing, and discussing watchful waiting into the decision-making process will benefit appropriate prescribing of antibiotics.</p>\",\"PeriodicalId\":36541,\"journal\":{\"name\":\"BJGP Open\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2025-04-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BJGP Open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.3399/BJGPO.2024.0166\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"PRIMARY HEALTH CARE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BJGP Open","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3399/BJGPO.2024.0166","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PRIMARY HEALTH CARE","Score":null,"Total":0}
The effect of a GP's perception of a patient request for antibiotics on antibiotic prescribing for respiratory tract infections: secondary analysis of a point-prevalence audit survey in 18 European countries.
Background: Illness severity, comorbidity, fever, age, and symptom duration influence antibiotic prescribing for respiratory tract infections (RTI). Non-medical determinants, such as patient expectations, also impact prescribing.
Aim: To quantify the effect of a GP's perception of a patient request for antibiotics on antibiotic prescribing for RTI and investigate effect modification by medical determinants and country.
Design & setting: Prospective audit of general practices in 18 European countries.
Method: Consultation data were registered of 4982 patients presenting with acute cough and/or sore throat. A mixed-effect logistic regression model analysed the effect of GPs' perceptions of a patient request for antibiotics. Two-way interaction terms assessed effect modification. Relevant clinical findings were added to subgroups of lower RTI (LRTI), throat infection, and influenza-like-illness (ILI).
Results: A GP's perception of a request for antibiotics meant they were four times more likely to prescribe antibiotics (odds ratio [OR] 4.4, 95% confidence interval [CI] = 3.4 to 5.5). This effect varied by country: lower in Spain (OR 0.06), Ukraine (OR 0.15), and Greece (OR 0.22) compared with the lowest prescribing country. The effect was higher for ILI (OR 13.86, 95% CI = 5.5 to 35) and throat infection (OR 5.1, 95% CI = 3.1 to 8.4) than for LRTI (OR 2.9, 95% CI = 1.9 to 4.3). For ILI and LRTI, GPs were more likely to prescribe antibiotics with abnormal lung auscultation and/or increased or purulent sputum and for throat infection, with tonsillar exudate and/or swollen tonsils.
Conclusion: GPs' perceptions of an antibiotic request and specific clinical findings influence antibiotic prescribing. Incorporating exploration of patient expectations, point-of-care testing, and discussing watchful waiting into the decision-making process will benefit appropriate prescribing of antibiotics.