Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Primary Care
Published in: BMC Primary Care 1/2011

Open Access 01-12-2011 | Research article

Use and feasibility of delayed prescribing for respiratory tract infections: A questionnaire survey

Authors: Sigurd Høye, Jan C Frich, Morten Lindbæk

Published in: BMC Primary Care | Issue 1/2011

Login to get access

Abstract

Background

Delayed prescribing of antibiotics for respiratory tract infections (RTIs) lowers the amount of antibiotics consumed. Several national treatment guidelines on RTIs recommend the strategy. When advocating treatment innovations, the feasibility and credibility of the innovation must be taken into account. The objective of this study was to explore GPs use and patients uptake of wait-and-see prescriptions for RTIs, and to investigate the feasibility of the strategy from GPs' and patients' perspectives.

Methods

Questionnaire survey among Norwegian GPs issuing and patients receiving a wait-and-see-prescription for RTIs. Patients reported symptoms, confidence and antibiotics consumption, GPs reported diagnoses, reason for issuing a wait-and-see-prescription and their opinion about the method.

Results

304 response pairs from consultations with 49 GPs were received. The patient response rate was 80%. The most common diagnosis for the GPs to issue a wait-and-see prescription was sinusitis (33%) and otitis (21%). 46% of the patients reported to consume the antibiotics. When adjusted for other factors, the diagnosis did not predict antibiotic consumption, but both being 16 years or more (p = 0,006) and reporting to have a fever (p = 0,012) doubled the odds of antibiotic consumption, while feeling very ill more than quadrupled the odds (p = 0,002). In 210 cases (69%), the GP found delayed prescribing a very reasonable strategy, and 270 patients (89%) would prefer to receive a wait-and-see prescription in a similar situation in the future. The GPs found delayed prescribing very reasonable most frequently in cases of sinusitis (79%, p = 0,007) and least frequently in cases of lower RTIs (49%, p = 0,002).

Conclusion

Most patients and GPs are satisfied with the delayed prescribing strategy. The patients' age, symptoms and malaise are more important than the diagnosis in predicting antibiotic consumption. The GP's view of the method as a reasonable approach depends on the patient's diagnosis. In our setting, delayed prescribing seems to be a feasible strategy, especially in cases of sinusitis and otitis. Educational efforts to promote delayed prescribing in similar settings should focus on these diagnoses.
Appendix
Available only for authorised users
Literature
1.
Straand J, Rokstad KS, Sandvik H: Prescribing systemic antibiotics in general practice. A report from the More & Romsdal Prescription Study. Scand J Prim Health Care. 1998, 16 (2): 121-127.CrossRefPubMed
2.
Arroll B: Antibiotics for upper respiratory tract infections: an overview of Cochrane reviews. Respir Med. 2005, 99 (3): 255-261.CrossRefPubMed
3.
Goossens H, Ferech M, Vander SR, Elseviers M: Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005, 365 (9459): 579-587.CrossRefPubMed
4.
Gjelstad S, Dalen I, Lindbaek M: GPs' antibiotic prescription patterns for respiratory tract infections - still room for improvement. Scand J Prim Health Care. 2009, 27 (4): 208-215.CrossRefPubMedPubMedCentral
5.
Little P, Gould C, Williamson I, Moore M, Warner G, Dunleavey J: Pragmatic randomised controlled trial of two prescribing strategies for childhood acute otitis media. BMJ. 2001, 322 (7282): 336-342.CrossRefPubMedPubMedCentral
6.
Spiro DM, Tay KY, Arnold DH, Dziura JD, Baker MD, Shapiro ED: Wait-and-see prescription for the treatment of acute otitis media: a randomized controlled trial. JAMA. 2006, 296 (10): 1235-1241.CrossRefPubMed
7.
Little P, Williamson I, Warner G, Gould C, Gantley M, Kinmonth AL: Open randomised trial of prescribing strategies in managing sore throat. BMJ. 1997, 314 (7082): 722-727.CrossRefPubMedPubMedCentral
8.
Dowell J, Pitkethly M, Bain J, Martin S: A randomised controlled trial of delayed antibiotic prescribing as a strategy for managing uncomplicated respiratory tract infection in primary care. Br J Gen Pract. 2001, 51 (464): 200-205.PubMedPubMedCentral
9.
Little P, Rumsby K, Kelly J, Watson L, Moore M, Warner G, et al: Information leaflet and antibiotic prescribing strategies for acute lower respiratory tract infection: a randomized controlled trial. JAMA. 2005, 293 (24): 3029-3035.CrossRefPubMed
10.
Arroll B, Kenealy T, Kerse N: Do delayed prescriptions reduce the use of antibiotics for the common cold? A single-blind controlled trial. J Fam Pract. 2002, 51 (4): 324-328.PubMed
11.
Spurling GK, Del Mar CB, Dooley L, Foxlee R: Delayed antibiotics for respiratory infections. Cochrane Database Syst Rev. 2007, CD004417-3
12.
Petursson P: GPs' reasons for "non-pharmacological" prescribing of antibiotics. A phenomenological study. Scand J Prim Health Care. 2005, 23 (2): 120-125.CrossRefPubMed
13.
Høye S, Frich JC, Lindbaek M: Delayed prescribing for upper respiratory tract infections: a qualitative study of general practitioners' views and experiences. Br J Gen Pract. 2010, 60 (581): 907-912.CrossRefPubMedPubMedCentral
14.
15.
Prescribing of antibiotics for self limiting respiratory tract infections in adults and children in primary care. 2008, National Institute for Health and Clinical Excellence, Clinical Guideline 69
16.
The Directorate of Health, The antibiotic center for primary helath care: [National guidelines for antibiotic use in primary health care]. 2008, Oslo: The Directorate of Health
17.
STRAMA, Medical Products Agency: [Diagnostics, treatment and follow-up of acute otitis media (AOM) - new recommendation]. Information from the Medical Products Agency. 2010, 21 (5): 13-24.
18.
Gjelstad S, Fetveit A, Straand J, Dalen I, Rognstad S, Lindbaek M: Can antibiotic prescriptions in respiratory tract infections be improved? A cluster-randomized educational intervention in general practice--the Prescription Peer Academic Detailing (Rx-PAD) Study [NCT00272155]. BMC Health Serv Res. 2006, 6: 75-CrossRefPubMedPubMedCentral
19.
McDermott L, Yardley L, Little P, Ashworth M, Gulliford M, Research Team: Developing a computer delivered, theory based intervention for guideline implementation in general practice. BMC Fam Pract. 2010, 11 (1): 90-CrossRefPubMedPubMedCentral
20.
Simpson SA, Butler CC, Hood K, Cohen D, Dunstan F, Evans MR, et al: Stemming the Tide of Antibiotic Resistance (STAR): a protocol for a trial of a complex intervention addressing the 'why' and 'how' of appropriate antibiotic prescribing in general practice. BMC Fam Pract. 2009, 10: 20-CrossRefPubMedPubMedCentral
21.
Arroll B, Goodyear-Smith F, Thomas DR, Kerse N: Delayed antibiotic prescriptions: what are the experiences and attitudes of physicians and patients?. J Fam Pract. 2002, 51 (11): 954-959.PubMed
22.
Edwards M, Dennison J, Sedgwick P: Patients' responses to delayed antibiotic prescription for acute upper respiratory tract infections. Br J Gen Pract. 2003, 53 (496): 845-850.PubMedPubMedCentral
23.
Grol R, Wensing M: What drives change? Barriers to and incentives for achieving evidence-based practice. Med J Aust. 2004, 180 (6 Suppl): S57-S60.PubMed
24.
Gjelstad S, Dalen I, Lindbaek M: GPs' antibiotic prescription patterns for respiratory tract infections--still room for improvement. Scand J Prim Health Care. 2009, 27 (4): 208-215.CrossRefPubMedPubMedCentral
25.
Sharland M, Kendall H, Yeates D, Randall A, Hughes G, Glasziou P, et al: Antibiotic prescribing in general practice and hospital admissions for peritonsillar abscess, mastoiditis, and rheumatic fever in children: time trend analysis. BMJ. 2005, 331 (7512): 328-329.CrossRefPubMedPubMedCentral
26.
Fagan M: [Is otitis and tonsillitis handled in the same way within normal working hours and out-of-hours?]. Tidsskr Nor Laegeforen. 2008, 128 (20): 2340-2342.PubMed
27.
Lagerlov P, Loeb M, Slettevoll J, Lingjaerde OC, Fetveit A: Severity of illness and the use of paracetamol in febrile preschool children; a case simulation study of parents' assessments. Fam Pract. 2006, 23 (6): 618-623.CrossRefPubMed
28.
Butler CC, Simpson S, Wood F: General practitioners' perceptions of introducing near-patient testing for common infections into routine primary care: a qualitative study. Scand J Prim Health Care. 2008, 26 (1): 17-21.CrossRefPubMedPubMedCentral
29.
Deschepper R, Vander Stichele RH, Haaijer-Ruskamp FM: Cross-cultural differences in lay attitudes and utilisation of antibiotics in a Belgian and a Dutch city. Patient Educ Couns. 2002, 48 (2): 161-169.CrossRefPubMed
30.
Glasziou PP, Del Mar CB, Sanders SL, Hayem M: Antibiotics for acute otitis media in children. Cochrane Database Syst Rev. 2004, CD000219-1
31.
Simpson SA, Wood F, Butler CC: General practitioners' perceptions of antimicrobial resistance: a qualitative study. J Antimicrob Chemother. 2007, 59 (2): 292-296.CrossRefPubMed
32.
Metadata
Title
Use and feasibility of delayed prescribing for respiratory tract infections: A questionnaire survey
Authors
Sigurd Høye
Jan C Frich
Morten Lindbæk
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2011
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/1471-2296-12-34

Other articles of this Issue 1/2011

BMC Primary Care 1/2011 Go to the issue

Research article

Effects of online palliative care training on knowledge, attitude and satisfaction of primary care physicians

Research article

Is the beck anxiety inventory a good tool to assess the severity of anxiety? A primary care study in The Netherlands study of depression and anxiety (NESDA)

Research article

Measuring the burden of herpes zoster and post herpetic neuralgia within primary care in rural Crete, Greece

Research article

Informed citizen and empowered citizen in health: results from an European survey

Research article

The use of pure and impure placebo interventions in primary care - a qualitative approach

Research article

Clinical prediction rules combining signs, symptoms and epidemiological context to distinguish influenza from influenza-like illnesses in primary care: a cross sectional study