Public preferences for delayed or immediate antibiotic prescriptions in UK primary care: A choice experiment.

<h4>Background</h4>Delayed (or "backup") antibiotic prescription, where the patient is given a prescription but advised to delay initiating antibiotics, has been shown to be effective in reducing antibiotic use in primary care. However, this strategy is not widely used in the U...

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Autores principales:	Liz Morrell, James Buchanan, Laurence S J Roope, Koen B Pouwels, Christopher C Butler, Benedict Hayhoe, Sarah Tonkin-Crine, Monsey McLeod, Julie V Robotham, Alison Holmes, A Sarah Walker, Sarah Wordsworth, STEPUP team
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/a8c4553c167c497e94ae5b802bd3fdd2
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id	oai:doaj.org-article:a8c4553c167c497e94ae5b802bd3fdd2
record_format	dspace
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Liz Morrell James Buchanan Laurence S J Roope Koen B Pouwels Christopher C Butler Benedict Hayhoe Sarah Tonkin-Crine Monsey McLeod Julie V Robotham Alison Holmes A Sarah Walker Sarah Wordsworth STEPUP team Public preferences for delayed or immediate antibiotic prescriptions in UK primary care: A choice experiment.
description	<h4>Background</h4>Delayed (or "backup") antibiotic prescription, where the patient is given a prescription but advised to delay initiating antibiotics, has been shown to be effective in reducing antibiotic use in primary care. However, this strategy is not widely used in the United Kingdom. This study aimed to identify factors influencing preferences among the UK public for delayed prescription, and understand their relative importance, to help increase appropriate use of this prescribing option.<h4>Methods and findings</h4>We conducted an online choice experiment in 2 UK general population samples: adults and parents of children under 18 years. Respondents were presented with 12 scenarios in which they, or their child, might need antibiotics for a respiratory tract infection (RTI) and asked to choose either an immediate or a delayed prescription. Scenarios were described by 7 attributes. Data were collected between November 2018 and February 2019. Respondent preferences were modelled using mixed-effects logistic regression. The survey was completed by 802 adults and 801 parents (75% of those who opened the survey). The samples reflected the UK population in age, sex, ethnicity, and country of residence. The most important determinant of respondent choice was symptom severity, especially for cough-related symptoms. In the adult sample, the probability of choosing delayed prescription was 0.53 (95% confidence interval (CI) 0.50 to 0.56, p < 0.001) for a chesty cough and runny nose compared to 0.30 (0.28 to 0.33, p < 0.001) for a chesty cough with fever, 0.47 (0.44 to 0.50, p < 0.001) for sore throat with swollen glands, and 0.37 (0.34 to 0.39, p < 0.001) for sore throat, swollen glands, and fever. Respondents were less likely to choose delayed prescription with increasing duration of illness (odds ratio (OR) 0.94 (0.92 to 0.96, p < 0.001)). Probabilities of choosing delayed prescription were similar for parents considering treatment for a child (44% of choices versus 42% for adults, p = 0.04). However, parents differed from the adult sample in showing a more marked reduction in choice of the delayed prescription with increasing duration of illness (OR 0.83 (0.80 to 0.87) versus 0.94 (0.92 to 0.96) for adults, p for heterogeneity p < 0.001) and a smaller effect of disruption of usual activities (OR 0.96 (0.95 to 0.97) versus 0.93 (0.92 to 0.94) for adults, p for heterogeneity p < 0.001). Females were more likely to choose a delayed prescription than males for minor symptoms, particularly minor cough (probability 0.62 (0.58 to 0.66, p < 0.001) for females and 0.45 (0.41 to 0.48, p < 0.001) for males). Older people, those with a good understanding of antibiotics, and those who had not used antibiotics recently showed similar patterns of preferences. Study limitations include its hypothetical nature, which may not reflect real-life behaviour; the absence of a "no prescription" option; and the possibility that study respondents may not represent the views of population groups who are typically underrepresented in online surveys.<h4>Conclusions</h4>This study found that delayed prescription appears to be an acceptable approach to reducing antibiotic consumption. Certain groups appear to be more amenable to delayed prescription, suggesting particular opportunities for increased use of this strategy. Prescribing choices for sore throat may need additional explanation to ensure patient acceptance, and parents in particular may benefit from reassurance about the usual duration of these illnesses.
format	article
author	Liz Morrell James Buchanan Laurence S J Roope Koen B Pouwels Christopher C Butler Benedict Hayhoe Sarah Tonkin-Crine Monsey McLeod Julie V Robotham Alison Holmes A Sarah Walker Sarah Wordsworth STEPUP team
author_facet	Liz Morrell James Buchanan Laurence S J Roope Koen B Pouwels Christopher C Butler Benedict Hayhoe Sarah Tonkin-Crine Monsey McLeod Julie V Robotham Alison Holmes A Sarah Walker Sarah Wordsworth STEPUP team
author_sort	Liz Morrell
title	Public preferences for delayed or immediate antibiotic prescriptions in UK primary care: A choice experiment.
title_short	Public preferences for delayed or immediate antibiotic prescriptions in UK primary care: A choice experiment.
title_full	Public preferences for delayed or immediate antibiotic prescriptions in UK primary care: A choice experiment.
title_fullStr	Public preferences for delayed or immediate antibiotic prescriptions in UK primary care: A choice experiment.
title_full_unstemmed	Public preferences for delayed or immediate antibiotic prescriptions in UK primary care: A choice experiment.
title_sort	public preferences for delayed or immediate antibiotic prescriptions in uk primary care: a choice experiment.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/a8c4553c167c497e94ae5b802bd3fdd2
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spelling	oai:doaj.org-article:a8c4553c167c497e94ae5b802bd3fdd22021-12-02T19:55:38ZPublic preferences for delayed or immediate antibiotic prescriptions in UK primary care: A choice experiment.1549-12771549-167610.1371/journal.pmed.1003737https://doaj.org/article/a8c4553c167c497e94ae5b802bd3fdd22021-08-01T00:00:00Zhttps://doi.org/10.1371/journal.pmed.1003737https://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>Delayed (or "backup") antibiotic prescription, where the patient is given a prescription but advised to delay initiating antibiotics, has been shown to be effective in reducing antibiotic use in primary care. However, this strategy is not widely used in the United Kingdom. This study aimed to identify factors influencing preferences among the UK public for delayed prescription, and understand their relative importance, to help increase appropriate use of this prescribing option.<h4>Methods and findings</h4>We conducted an online choice experiment in 2 UK general population samples: adults and parents of children under 18 years. Respondents were presented with 12 scenarios in which they, or their child, might need antibiotics for a respiratory tract infection (RTI) and asked to choose either an immediate or a delayed prescription. Scenarios were described by 7 attributes. Data were collected between November 2018 and February 2019. Respondent preferences were modelled using mixed-effects logistic regression. The survey was completed by 802 adults and 801 parents (75% of those who opened the survey). The samples reflected the UK population in age, sex, ethnicity, and country of residence. The most important determinant of respondent choice was symptom severity, especially for cough-related symptoms. In the adult sample, the probability of choosing delayed prescription was 0.53 (95% confidence interval (CI) 0.50 to 0.56, p < 0.001) for a chesty cough and runny nose compared to 0.30 (0.28 to 0.33, p < 0.001) for a chesty cough with fever, 0.47 (0.44 to 0.50, p < 0.001) for sore throat with swollen glands, and 0.37 (0.34 to 0.39, p < 0.001) for sore throat, swollen glands, and fever. Respondents were less likely to choose delayed prescription with increasing duration of illness (odds ratio (OR) 0.94 (0.92 to 0.96, p < 0.001)). Probabilities of choosing delayed prescription were similar for parents considering treatment for a child (44% of choices versus 42% for adults, p = 0.04). However, parents differed from the adult sample in showing a more marked reduction in choice of the delayed prescription with increasing duration of illness (OR 0.83 (0.80 to 0.87) versus 0.94 (0.92 to 0.96) for adults, p for heterogeneity p < 0.001) and a smaller effect of disruption of usual activities (OR 0.96 (0.95 to 0.97) versus 0.93 (0.92 to 0.94) for adults, p for heterogeneity p < 0.001). Females were more likely to choose a delayed prescription than males for minor symptoms, particularly minor cough (probability 0.62 (0.58 to 0.66, p < 0.001) for females and 0.45 (0.41 to 0.48, p < 0.001) for males). Older people, those with a good understanding of antibiotics, and those who had not used antibiotics recently showed similar patterns of preferences. Study limitations include its hypothetical nature, which may not reflect real-life behaviour; the absence of a "no prescription" option; and the possibility that study respondents may not represent the views of population groups who are typically underrepresented in online surveys.<h4>Conclusions</h4>This study found that delayed prescription appears to be an acceptable approach to reducing antibiotic consumption. Certain groups appear to be more amenable to delayed prescription, suggesting particular opportunities for increased use of this strategy. Prescribing choices for sore throat may need additional explanation to ensure patient acceptance, and parents in particular may benefit from reassurance about the usual duration of these illnesses.Liz MorrellJames BuchananLaurence S J RoopeKoen B PouwelsChristopher C ButlerBenedict HayhoeSarah Tonkin-CrineMonsey McLeodJulie V RobothamAlison HolmesA Sarah WalkerSarah WordsworthSTEPUP teamPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 18, Iss 8, p e1003737 (2021)

Public preferences for delayed or immediate antibiotic prescriptions in UK primary care: A choice experiment.

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