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Expectations for consultations and antibiotics for respiratory tract infection in primary care: the RTI clinical iceberg

McNulty, Cliodna, Nichols, Tom, French, D, Joshi, P and Butler, Christopher Collett 2013. Expectations for consultations and antibiotics for respiratory tract infection in primary care: the RTI clinical iceberg. British Journal of General Practice 63 (612) , e429-e436. 10.3399/bjgp13X669149

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BACKGROUND: Respiratory tract infection (RTI) is the commonest indication for community antibiotic prescriptions. Prescribing is rising and is influenced by patients' consulting behaviour and beliefs. AIM: To build up a profile of the 'RTI clinical iceberg' by exploring how the general public manage RTI, visit GPs and why. DESIGN AND SETTING: Two-phase qualitative and quantitative study in England. METHOD: Qualitative interviews with 17 participants with acute RTI visiting pharmacies in England, and face-to-face questionnaire survey of 1767 adults ≥15 years in households in England during January 2011. RESULTS: Qualitative interviews: interviewees with RTI visited GPs if they considered their symptoms were prolonged, or severe enough to cause pain, or interfered with daily activities or sleep. Questionnaire: 58% reported having had an RTI in the previous 6 months, and 19.7% (95% CI = 16.8 to 22.9%) of these contacted or visited their GP surgery for this, most commonly because 'the symptoms were severe'; or 'after several days the symptoms hadn't improved'; 10.3% of those experiencing an RTI (or 53.1% of those contacting their GP about it) expected an antibiotic prescription. Responders were more likely to believe antibiotics would be effective for a cough with green rather than clear phlegm. Perceptions of side effects of antibiotics did not influence expectations for antibiotics. Almost all who reported asking for an antibiotic were prescribed one, but 25% did not finish them. CONCLUSION: One-fifth of those with an RTI contact their GP and most who ask for antibiotics are prescribed them. A better public understanding about the lack of benefit of antibiotics for most RTIs and addressing concerns about illness duration and severity, could reduce GP consultations and antibiotic prescriptions for RTI.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
Uncontrolled Keywords: Acute Disease;Adult;Anti-Bacterial Agents/administration & dosage*;Drug Administration Schedule;Drug Resistance, Bacterial;England/epidemiology;Female;General Practice*; Health Knowledge, Attitudes, Practice;Humans;Male;Medication Adherence/statistics & numerical data*;Patient Satisfaction*;Practice Patterns, Physicians'*/standards; Practice Patterns, Physicians'*/statistics & numerical data;Primary Health Care*/standards;Primary Health Care*/trends;Qualitative Research;Referral and Consultation*;Respiratory Tract Infections/diagnosis; Respiratory Tract Infections/drug therapy*;Respiratory Tract Infections/epidemiology;Surveys and Questionnaires
Publisher: Royal College of General Practitioners
ISSN: 0960-1643
Date of Acceptance: July 2013
Last Modified: 10 May 2018 06:32

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