Waiting room intervention lowers patients' expectations about antibiotics
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An intervention that was administered just before patients visited their family practitioner significantly reduced their expectations about receiving antibiotics for an upper respiratory tract infection, trial data show.
However, the intervention did not change the family practitioners’ prescribing patterns, researchers reported.
“Clinicians and patients play an important role in reducing inappropriate antibiotic prescribing, but we are in need of effective and scalable interventions to help us do so,” Anna Ishani Perera, MBChB, of the department of psychological medicine at the University of Auckland in New Zealand, told Healio Primary Care.
Providers often face pressure from patients to prescribe antibiotics, which Perera said is a driver of inappropriate prescribing.
The researchers asked 325 patients (median age, 39 years; 69% women) who presented at one of two family medicine clinics in New Zealand with influenza or a cold to complete a seven-point Likert scale questionnaire. The patients were asked about severity of their illness — or in some cases, parents were asked about their child’s illness — as well as their attitudes toward antibiotics to treat upper respiratory tract infections and their expectations for receiving them.
The patients were randomly assigned to watch one of three slide presentations on a tablet device: the first discussed the uselessness of antibiotics for upper respiratory tract infections and provided information about alternative treatments; the second addressed possible adverse events associated with antibiotic use as well as provided information about alternative treatments; and the third (control) encouraged healthy lifestyle choices and did not mention antibiotics or upper respiratory tract infections. As soon as the video was over, patients were asked about their level of agreement with the following statements: “I think antibiotics are a helpful treatment for cold/flu,” and, “I wish to receive antibiotics for my/my child’s cold/flu.” The patient (and, where applicable, their child) then saw the family physician. Although clinicians knew about the trial, they did not know which patients participated in the intervention or which slide presentations the patients had seen.
“Both the family practices involved in our study had existing low levels of antibiotic prescribing compared with other practices in New Zealand, thus essentially giving the intervention less power to reduce antibiotic prescribing to a statistically significant level,” Perera said in the interview.
The researchers reported that patients who watched the presentation on the uselessness of antibiotics for upper respiratory tract infections or the presentation on adverse events had significantly reduced expectations to receive antibiotics (mean reduction = 1.1 [95% CI, 0.8-1.3] and 0.7 [95% CI, 0.4-0.9], respectively) compared with the control group (mean reduction = 0.1 [95% CI, 0-0.3]).
There was no significant difference between the three cohorts regarding physician antibiotic prescribing or dispensing behaviors.
Perera speculated that if the intervention was employed at other practices with higher prescribing rates, it “would be able to significantly reduce antibiotic prescribing.” However, the study was not powered to ascertain why the intervention had failed to curb antibiotic prescriptions. She mentioned a larger trial scheduled for 2022 that will focus on the physician-patient consultation in a “more diverse range of family practices” and will seek to positively influence physicians’ antibiotic prescribing behaviors.
Perspective
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Corneilius "Neil" J. Clancy, MD
Lots of times, health care professionals are either told, get the impression from their patients or feel implicit or explicit pressure to give antibiotics to their patients, even if the antibiotics are unlikely to be of benefit.
This study by Perera and colleagues shows we must continue to educate providers and patients. Lots of times, health care providers assume patients who do not get their requested antibiotics will get them elsewhere. But I often find that if you explain why antibiotics may not be useful and dangerous because of the side effects that we see, patients’ attitudes change.
The message from this study is to communicate to your patients on whether they need antibiotics or not and why. You might very well be surprised that the patients are not looking for them to the extent that you think they are. This is a particularly relevant message in the COVID-19 era, where patients may think antibiotics would be beneficial when science clearly showed they were not.
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