Patient expectations, doctors' prescribing habits, and antimicrobial resistance

Inappropriate antibiotic prescribing for upper respiratory tract infections contributes to antibiotic resistance, making some bacterial infections difficult to treat. This often leads to higher medical costs, prolonged hospital stays and increased mortality. Still, many physicians report prescribing antibiotics at their patients' request. To address patients' expectations for antibiotic prescribing for URTIs, researchers conducted an experiment in which study participants were assigned brief educational videos to watch on a tablet immediately prior to their appointment.

The authors randomized patients into three groups - one that viewed a presentation about the futility of antibiotic treatment of URTIs; a second group that viewed a presentation about the adverse effects associated with antibiotics; and a third control group that learned about the benefits of healthy diet/exercise. The researchers then measured the effects of the presentations on patients' beliefs that antibiotics are helpful for URTIs; their expectations to be prescribed an antibiotic; and whether they were actually prescribed antibiotics for their URTIs. Participants who viewed either the futility or adverse effects presentations had greater reductions in their expectations of receiving antibiotics compared to the group that viewed the video about the benefits of healthy/diet and exercise. However, there was no significant difference between the three groups when it came to doctors actually prescribing antibiotics to patients. Researchers concluded that a brief, tablet-based waiting room intervention significantly changes participants' expectations on receiving antibiotics for URTIs, but that future efforts to improve antibiotic prescribing need to involve both patients and their doctors.

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Reducing Expectations for Antibiotics in Patients With Upper Respiratory Tract Infections: A Primary Care Randomized Controlled Trial
Anna Perera, MBChB, et al
University of Auckland, Department of Psychological Medicine, Auckland, New Zealand
https://www.annfammed.org/content/19/3/232