Are patient views about antibiotics related to clinician perceptions, management and outcome? A multi-country study in outpatients with acute cough.

<h4>Background</h4>Outpatients with acute cough who expect, hope for or ask for antibiotics may be more unwell, benefit more from antibiotic treatment, and be more satisfied with care when they are prescribed antibiotics. Clinicians may not accurately identify those patients.<h4>Ob...

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Autores principales:	Samuel Coenen, Nick Francis, Mark Kelly, Kerenza Hood, Jacqui Nuttall, Paul Little, Theo J M Verheij, Hasse Melbye, Herman Goossens, Christopher C Butler, GRACE Project Group
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/6d3593304aff471d94435d195b3a5b89
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spelling	oai:doaj.org-article:6d3593304aff471d94435d195b3a5b892021-11-18T08:49:52ZAre patient views about antibiotics related to clinician perceptions, management and outcome? A multi-country study in outpatients with acute cough.1932-620310.1371/journal.pone.0076691https://doaj.org/article/6d3593304aff471d94435d195b3a5b892013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24194845/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Outpatients with acute cough who expect, hope for or ask for antibiotics may be more unwell, benefit more from antibiotic treatment, and be more satisfied with care when they are prescribed antibiotics. Clinicians may not accurately identify those patients.<h4>Objective</h4>To explore whether patient views (expecting, hoping for or asking for antibiotics) are associated with illness presentation and resolution, whether patient views are accurately perceived by clinicians, and the association of all these factors with antibiotic prescribing and patient satisfaction with care.<h4>Methods</h4>Prospective observational study of 3402 adult patients with acute cough presenting in 14 primary care networks. Correlations and associations tested with multilevel logistic regression and McNemar 's tests, and Cohen's Kappa, positive agreement (PA) and negative agreement (NA) calculated as appropriate.<h4>Results</h4>1,213 (45.1%) patients expected, 1,093 (40.6%) hoped for, and 275 (10.2%) asked for antibiotics. Clinicians perceived 840 (31.3%) as wanting to be prescribed antibiotics (McNemar's test, p<0.05). Their perception agreed modestly with the three patient views (Kappa's = 0.29, 0.32 and 0.21, PA's = 0.56, 0.56 and 0.33, NA's = 0.72, 0.75 and 0.82, respectively). 1,464 (54.4%) patients were prescribed antibiotics. Illness presentation and resolution were similar for patients regardless their views. These associations were not modified by antibiotic treatment. Patient expectation and hope (OR:2.08, 95% CI:[1.48,2.93] and 2.48 [1.73,3.55], respectively), and clinician perception (12.18 [8.31,17.84]) were associated with antibiotic prescribing. 2,354 (92.6%) patients were satisfied. Only those hoping for antibiotics were less satisfied when antibiotics were not prescribed (0.39 [0.17,0.90]).<h4>Conclusion</h4>Patient views about antibiotic treatment were not useful for identifying those who will benefit from antibiotics. Clinician perceptions did not match with patient views, but particularly influenced antibiotic prescribing. Patients were generally satisfied with care, but those hoping for but not prescribed antibiotics were less satisfied. Clinicians need to more effectively elicit and address patient views about antibiotics.Samuel CoenenNick FrancisMark KellyKerenza HoodJacqui NuttallPaul LittleTheo J M VerheijHasse MelbyeHerman GoossensChristopher C ButlerGRACE Project GroupPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 10, p e76691 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Samuel Coenen Nick Francis Mark Kelly Kerenza Hood Jacqui Nuttall Paul Little Theo J M Verheij Hasse Melbye Herman Goossens Christopher C Butler GRACE Project Group Are patient views about antibiotics related to clinician perceptions, management and outcome? A multi-country study in outpatients with acute cough.
description	<h4>Background</h4>Outpatients with acute cough who expect, hope for or ask for antibiotics may be more unwell, benefit more from antibiotic treatment, and be more satisfied with care when they are prescribed antibiotics. Clinicians may not accurately identify those patients.<h4>Objective</h4>To explore whether patient views (expecting, hoping for or asking for antibiotics) are associated with illness presentation and resolution, whether patient views are accurately perceived by clinicians, and the association of all these factors with antibiotic prescribing and patient satisfaction with care.<h4>Methods</h4>Prospective observational study of 3402 adult patients with acute cough presenting in 14 primary care networks. Correlations and associations tested with multilevel logistic regression and McNemar 's tests, and Cohen's Kappa, positive agreement (PA) and negative agreement (NA) calculated as appropriate.<h4>Results</h4>1,213 (45.1%) patients expected, 1,093 (40.6%) hoped for, and 275 (10.2%) asked for antibiotics. Clinicians perceived 840 (31.3%) as wanting to be prescribed antibiotics (McNemar's test, p<0.05). Their perception agreed modestly with the three patient views (Kappa's = 0.29, 0.32 and 0.21, PA's = 0.56, 0.56 and 0.33, NA's = 0.72, 0.75 and 0.82, respectively). 1,464 (54.4%) patients were prescribed antibiotics. Illness presentation and resolution were similar for patients regardless their views. These associations were not modified by antibiotic treatment. Patient expectation and hope (OR:2.08, 95% CI:[1.48,2.93] and 2.48 [1.73,3.55], respectively), and clinician perception (12.18 [8.31,17.84]) were associated with antibiotic prescribing. 2,354 (92.6%) patients were satisfied. Only those hoping for antibiotics were less satisfied when antibiotics were not prescribed (0.39 [0.17,0.90]).<h4>Conclusion</h4>Patient views about antibiotic treatment were not useful for identifying those who will benefit from antibiotics. Clinician perceptions did not match with patient views, but particularly influenced antibiotic prescribing. Patients were generally satisfied with care, but those hoping for but not prescribed antibiotics were less satisfied. Clinicians need to more effectively elicit and address patient views about antibiotics.
format	article
author	Samuel Coenen Nick Francis Mark Kelly Kerenza Hood Jacqui Nuttall Paul Little Theo J M Verheij Hasse Melbye Herman Goossens Christopher C Butler GRACE Project Group
author_facet	Samuel Coenen Nick Francis Mark Kelly Kerenza Hood Jacqui Nuttall Paul Little Theo J M Verheij Hasse Melbye Herman Goossens Christopher C Butler GRACE Project Group
author_sort	Samuel Coenen
title	Are patient views about antibiotics related to clinician perceptions, management and outcome? A multi-country study in outpatients with acute cough.
title_short	Are patient views about antibiotics related to clinician perceptions, management and outcome? A multi-country study in outpatients with acute cough.
title_full	Are patient views about antibiotics related to clinician perceptions, management and outcome? A multi-country study in outpatients with acute cough.
title_fullStr	Are patient views about antibiotics related to clinician perceptions, management and outcome? A multi-country study in outpatients with acute cough.
title_full_unstemmed	Are patient views about antibiotics related to clinician perceptions, management and outcome? A multi-country study in outpatients with acute cough.
title_sort	are patient views about antibiotics related to clinician perceptions, management and outcome? a multi-country study in outpatients with acute cough.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/6d3593304aff471d94435d195b3a5b89
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Are patient views about antibiotics related to clinician perceptions, management and outcome? A multi-country study in outpatients with acute cough.

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