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Boğaz ağrılı hastalarda hekimlerin antibiyotik yazma davranışları: Aile hekimleriyle KBB hekimlerinin karşılaştırılması

Year 2020, Volume: 14 Issue: 4, 657 - 665, 20.12.2020
https://doi.org/10.21763/tjfmpc.743319

Abstract

Amaç: Bu çalışmanın amacı, kulak-burun-boğaz uzmanları ve aile hekimlerinin, boğaz ağrısı yakınmasıyla kendilerine başvuran hastalarda antibiyotik beklentisi algıları ve antibiyotik yazma davranışlarıyla bunlarla ilişkili etkenleri araştırmaktı. Yöntem: Şubat 2014 ve Şubat 2015 tarihleri arasında Adnan Menderes Üniversitesi Hastanesi Kulak Burun Boğaz Hastalıkları polikliniğinde ve Aile Hekimliği polikliniği ile afiliye çalışan aile hekimleriyle ileriye dönük tanımlayıcı bir çalışma yapıldı. Başlıca yakınması boğaz ağrısı olan 384 hasta ve 26 hekim çalışma nüfusunu oluşturdu. Katılımcılara hasta ve hekim anketleri uygulandı. İstatistiksel değerlendirme için t testi, Ki-kare testi ve çoklu lojistik regresyon analizi kullanıldı. Bulgular: Boğaz ağrısı olan hastaların %10’unda antibiyotik beklentisi vardı. Hekimler hastaların %48,4’ünde antibiyotik beklentisi algıladı ve %53,4’ü hastalarına antibiyotik yazdı. Hastalardaki antibiyotik beklentisi, hekimlerin hastalardaki antibiyotik beklentilerine ilişkin algısı ve antibiyotik yazma davranışı üzerinde etkili değildi. Daha az deneyimli hekimler (10,6 kat), aile hekimleri (7,0 kat) ve hastalarında antibiyotik beklentisi algılayan hekimler (5,8 kat) daha çok antibiyotik yazmıştı; kentsel bölgelerde yaşayan hastalara daha çok antibiyotik yazılmıştı (3,2 kat). Sonuç: Boğaz ağrılı hastaların antibiyotik beklentileri oldukça düşüktür. Aile hekimi olma, hekimin hastasında antibiyotik beklentisi algılaması, mesleksel deneyim eksikliği ve kentsel bölgede yaşama, hekimlerin antibiyotik yazma davranışı üzerinde etkili faktörlerdir.

Supporting Institution

Aydın Adnan Menderes Üniversitesi Bilimsel Araştırma Projeleri Komisyonu

Project Number

TPF-13002

References

  • 1. Little P, Williamson I. Sore throat management in general practice. Fam Pract 1996; 13: 317­21.
  • 2. Butler CC, Rollnick S, Pill R, Maggs-Rapport F, Stott N. Understanding the culture of prescribing: qualitative study of general practitioners’ and patients’ perceptions of antibiotics for sore throats. BMJ 1998; 317: 637–42.
  • 3. Seppala H, Klaukka T, Vuopio­Varkila J, et al. The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland. N Engl J Med 1997; 337: 441­6.
  • 4. Goossens H, Ferech M, Vander Stichele R, Elseviers M, ESAC Project Group. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 2005; 365:548–9.
  • 5. Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ 2010; 340: c2096. doi: 10.1136/bmj.c2096.
  • 6. Del Mar CB, Glasziou PP, Spinks AB. Antibiotics for sore throat. Cochrane Database Syst Rev 2004; 2: CD000023.
  • 7. Cockburn J, Pit S. Prescribing behaviour in clinical practice: patients’ expectations and doctors’ perceptions of patients expectations-a questionnaire study. Br Med J 1997; 315:520-3.
  • 8. Miller E, MacKeigan LD, Rosser W, Marshman J. Effects of perceived patient demand on prescribing anti-infective drugs. CMAJ 1999; 161: 139-42.
  • 9. Weiss MC, Deave T, Peters TJ, Salisbury C. Perceptions of patient expectation for an antibiotic:a comparison of walk-in centre nurses and GPs. Fam Pract 2004; 21: 492-9.
  • 10. Britten N, Okoumunne O. The influence of patients’ hopes of receiving a prescription on doctors’ perceptions and the decision to prescribe: a questionnaire survery. Br Med J 1997; 315: 1506-10.
  • 11. Yoon JP, Oh JH, Min WK, Kim JW, Jeong WJ, Lee HJ. What Do the Patients Want and Worry in Korean Patients Who Undergo Arthroscopic Rotator Cuff Surgery? Clin Orthop Surg 2012; 4: 278-83.
  • 12. Arch G, Mainows III, Zoorob RJ, Oler M, Hayned DM. Patient knowledge of upper respiratory infections: implications for antibiotic expectations and unnecessary utilisation. J Fam Pract 1997; 45: 75­82.
  • 13. Tunger Ö, Karakaya Y, Çetin B, Dinç G, Borand H. Rational antibiotic use. [Article in Turkish] J Infect Dev Ctries 2009; 3: 88-93.
  • 14. Erbay A, Colpan A, Bodur H, Cevik MA, Samore MH, Ergonul O. Evaluation of antibiotic use in a hospital with an antibiotic restriction policy. [Article in Turkish] Int J Antimicrob Agents 2003; 21: 308-12.
  • 15. Buke C, Hosgor-Limoncu M, Ermertcan S, et al. Irrational use of antibiotics among university students. [Article in Turkish] J Infect 2005; 51: 135-9.
  • 16. Akıcı A, Uğurlu MÜ, Kalaça S, Akıcı NG, Oktay Ş. Evaluation of the drug choice of general practitioners in the treatment of upper respiratory tract infections. [Article in Turkish] STED 2004; 13: 263-7.
  • 17. Leblebicioglu H, Canbaz S, Peksen Y, Gunaydin M. Physicians' antibiotic prescribing habits for upper respiratory tract infections in Turkey. [Article in Turkish] J Chemother 2002; 14: 181-4.
  • 18. Akıcı A, Kalaça S, Uğurlu MU, Oktay Ş. Prescribing habits of general practitioners in the treatment of childhood respiratory-tract infections. [Article in Turkish] Eur J Clin Pharmacol. 2004; 60: 211-6.
  • 19. Karabay O, Özdemir D, Güçlü E, et al. Attitudes and behaviors of family physicians regarding use of antibiotics. [Article in Turkish] J Microbiol Infect Dis 2011; 1: 53-7.
  • 20. Mollahaliloğlu S, Alkan A, Donertas B, Ozgulcu S, Akıcı A. (2013) Prescribing practices of physicians at different health care ınstitutions. [Article in Turkish] Eurasian J Med 2013; 45: 92-8.
  • 21. Çöplü N, İlhan MN, Ciliv FE, Şenlik ZB, Ertek M. Rational prescription of antibiotics among family physicians and specialists: attitudes and demands. [Article in Turkish] Turk Hij Den Biyol Derg 2014; 71: 19-26.
  • 22. Tonkin-Crine S, Yardley L, Little P. Antibiotic prescribing for acute repiratory tract infections im primary care: a systematic review and meta-etnography. J Antimicrob Chemother 2011; 66: 2215-23.
  • 23. Bjornsdottir I, Hansen EH. Intentions, strategies and uncertainty inherent in antibiotic prescribing. Eur J Gen Pract 2002; 8: 18-24.
  • 24. Petursson P. GPs’ reasons for “non-pharmacological” prescribing of antibiotics. A phenomenological study. Scand J Prim Health Care 2005; 23: 120–5.
  • 25. Barriere SL. Clinical, economic and societal impact of antibiotic resistance. Expert Opin Pharmacother 2015; 16: 151-3.
  • 26. Webb S, Lloyd M. Prescribing and referral in general practice: a study of patients' expectations and doctors' actions. Br J Gen Pract 1994; 44: 165-9.
  • 27. Howie JG, Foggo BA. Antibiotics, sore throats and rheumatic fever. J R Coll Gen Pract 1985; 35: 223-4.
  • 28. Lado E, Vacariza M, Fernandez-Gonzalez C, Gestal-Otero JJ, Figueiras A. Influence exerted on drug prescribing by patients’ attitudes and expectations and by doctors’ perception of such expectations: a cohort and nested case-control study. J Eval Clin Pract 2008; 14: 453-9.
  • 29. Schmidt HG, Norman GR, Boshuizen HPA. A cognitive perspective on medical expertise: theory and implications. Acad Med 1990; 65: 611-21.

Physicians’ antibiotic prescription behaviors in patients with sore throat: a comparison of family physicians and ENT doctors

Year 2020, Volume: 14 Issue: 4, 657 - 665, 20.12.2020
https://doi.org/10.21763/tjfmpc.743319

Abstract

Objective: The aim of the study was to investigate the antibiotic prescription behaviors of the physicians and their perceptions of antibiotic expectations of the patients presenting to ear-nose-throat specialists, and family physicians with the primary complaint of sore throat and related factors. Methods: A prospective descriptive study was conducted at Adnan Menderes University Hospital, Outpatient Clinics of Otorhinolaryngology, together with family physicians practicing in affiliation with Family Medicine Outpatient Clinics, between February 2014 and February 2015. The study population consisted of 384 patients with the main complaint of sore throat and 26 physicians. Patient and physician questionnaires were applied to the participants. For statistical evaluation, t-test, Chi-square test and multiple logistic regression analysis were used. Results: Ten percent of the patients with sore throat had an expectation of antibiotic. The physicians perceived an expectation for antibiotics in 48.4% of the patients and 53.4% of them prescribed antibiotics to their patients. The patients’ expectations for antibiotics were not effective on physicians’ perceptions of patients’ antibiotic expectations or their antibiotic prescription behavior. The less experienced physicians (10.6 fold), family physicians (7.0 fold) and physicians who perceived expectation of their patients for antibiotics (5.8 fold) prescribed more antibiotics; patients living in urban areas were prescribed more antibiotics (3.2 fold). Conclusion: Antibiotic expectation of the patients with a sore throat is very low. Being a family physician, physician’s perception of patient’s antibiotic expectation, lack of professional experience, and living in urban area are the factors effective on physician’s antibiotic prescribing behavior.

Project Number

TPF-13002

References

  • 1. Little P, Williamson I. Sore throat management in general practice. Fam Pract 1996; 13: 317­21.
  • 2. Butler CC, Rollnick S, Pill R, Maggs-Rapport F, Stott N. Understanding the culture of prescribing: qualitative study of general practitioners’ and patients’ perceptions of antibiotics for sore throats. BMJ 1998; 317: 637–42.
  • 3. Seppala H, Klaukka T, Vuopio­Varkila J, et al. The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland. N Engl J Med 1997; 337: 441­6.
  • 4. Goossens H, Ferech M, Vander Stichele R, Elseviers M, ESAC Project Group. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 2005; 365:548–9.
  • 5. Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ 2010; 340: c2096. doi: 10.1136/bmj.c2096.
  • 6. Del Mar CB, Glasziou PP, Spinks AB. Antibiotics for sore throat. Cochrane Database Syst Rev 2004; 2: CD000023.
  • 7. Cockburn J, Pit S. Prescribing behaviour in clinical practice: patients’ expectations and doctors’ perceptions of patients expectations-a questionnaire study. Br Med J 1997; 315:520-3.
  • 8. Miller E, MacKeigan LD, Rosser W, Marshman J. Effects of perceived patient demand on prescribing anti-infective drugs. CMAJ 1999; 161: 139-42.
  • 9. Weiss MC, Deave T, Peters TJ, Salisbury C. Perceptions of patient expectation for an antibiotic:a comparison of walk-in centre nurses and GPs. Fam Pract 2004; 21: 492-9.
  • 10. Britten N, Okoumunne O. The influence of patients’ hopes of receiving a prescription on doctors’ perceptions and the decision to prescribe: a questionnaire survery. Br Med J 1997; 315: 1506-10.
  • 11. Yoon JP, Oh JH, Min WK, Kim JW, Jeong WJ, Lee HJ. What Do the Patients Want and Worry in Korean Patients Who Undergo Arthroscopic Rotator Cuff Surgery? Clin Orthop Surg 2012; 4: 278-83.
  • 12. Arch G, Mainows III, Zoorob RJ, Oler M, Hayned DM. Patient knowledge of upper respiratory infections: implications for antibiotic expectations and unnecessary utilisation. J Fam Pract 1997; 45: 75­82.
  • 13. Tunger Ö, Karakaya Y, Çetin B, Dinç G, Borand H. Rational antibiotic use. [Article in Turkish] J Infect Dev Ctries 2009; 3: 88-93.
  • 14. Erbay A, Colpan A, Bodur H, Cevik MA, Samore MH, Ergonul O. Evaluation of antibiotic use in a hospital with an antibiotic restriction policy. [Article in Turkish] Int J Antimicrob Agents 2003; 21: 308-12.
  • 15. Buke C, Hosgor-Limoncu M, Ermertcan S, et al. Irrational use of antibiotics among university students. [Article in Turkish] J Infect 2005; 51: 135-9.
  • 16. Akıcı A, Uğurlu MÜ, Kalaça S, Akıcı NG, Oktay Ş. Evaluation of the drug choice of general practitioners in the treatment of upper respiratory tract infections. [Article in Turkish] STED 2004; 13: 263-7.
  • 17. Leblebicioglu H, Canbaz S, Peksen Y, Gunaydin M. Physicians' antibiotic prescribing habits for upper respiratory tract infections in Turkey. [Article in Turkish] J Chemother 2002; 14: 181-4.
  • 18. Akıcı A, Kalaça S, Uğurlu MU, Oktay Ş. Prescribing habits of general practitioners in the treatment of childhood respiratory-tract infections. [Article in Turkish] Eur J Clin Pharmacol. 2004; 60: 211-6.
  • 19. Karabay O, Özdemir D, Güçlü E, et al. Attitudes and behaviors of family physicians regarding use of antibiotics. [Article in Turkish] J Microbiol Infect Dis 2011; 1: 53-7.
  • 20. Mollahaliloğlu S, Alkan A, Donertas B, Ozgulcu S, Akıcı A. (2013) Prescribing practices of physicians at different health care ınstitutions. [Article in Turkish] Eurasian J Med 2013; 45: 92-8.
  • 21. Çöplü N, İlhan MN, Ciliv FE, Şenlik ZB, Ertek M. Rational prescription of antibiotics among family physicians and specialists: attitudes and demands. [Article in Turkish] Turk Hij Den Biyol Derg 2014; 71: 19-26.
  • 22. Tonkin-Crine S, Yardley L, Little P. Antibiotic prescribing for acute repiratory tract infections im primary care: a systematic review and meta-etnography. J Antimicrob Chemother 2011; 66: 2215-23.
  • 23. Bjornsdottir I, Hansen EH. Intentions, strategies and uncertainty inherent in antibiotic prescribing. Eur J Gen Pract 2002; 8: 18-24.
  • 24. Petursson P. GPs’ reasons for “non-pharmacological” prescribing of antibiotics. A phenomenological study. Scand J Prim Health Care 2005; 23: 120–5.
  • 25. Barriere SL. Clinical, economic and societal impact of antibiotic resistance. Expert Opin Pharmacother 2015; 16: 151-3.
  • 26. Webb S, Lloyd M. Prescribing and referral in general practice: a study of patients' expectations and doctors' actions. Br J Gen Pract 1994; 44: 165-9.
  • 27. Howie JG, Foggo BA. Antibiotics, sore throats and rheumatic fever. J R Coll Gen Pract 1985; 35: 223-4.
  • 28. Lado E, Vacariza M, Fernandez-Gonzalez C, Gestal-Otero JJ, Figueiras A. Influence exerted on drug prescribing by patients’ attitudes and expectations and by doctors’ perception of such expectations: a cohort and nested case-control study. J Eval Clin Pract 2008; 14: 453-9.
  • 29. Schmidt HG, Norman GR, Boshuizen HPA. A cognitive perspective on medical expertise: theory and implications. Acad Med 1990; 65: 611-21.
There are 29 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Orijinal Articles
Authors

Yeşim Başal This is me 0000-0001-9002-0619

Hatice Sema Başak 0000-0003-0687-975X

Aylin Eryılmaz 0000-0002-1417-7267

Ceren Günel This is me 0000-0002-1760-6397

Okay Başak 0000-0003-4669-3976

Project Number TPF-13002
Publication Date December 20, 2020
Submission Date May 27, 2020
Published in Issue Year 2020 Volume: 14 Issue: 4

Cite

Vancouver Başal Y, Başak HS, Eryılmaz A, Günel C, Başak O. Physicians’ antibiotic prescription behaviors in patients with sore throat: a comparison of family physicians and ENT doctors. TJFMPC. 2020;14(4):657-65.

English or Turkish manuscripts from authors with new knowledge to contribute to understanding and improving health and primary care are welcome.