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Article: Help-seeking and antibiotic prescribing for acute cough in a Chinese primary care population: a prospective multicentre observational study

TitleHelp-seeking and antibiotic prescribing for acute cough in a Chinese primary care population: a prospective multicentre observational study
Authors
Issue Date2016
PublisherNature Publishing Group: Open Access Journals - Option C. The Journal's web site is located at http://www.nature.com/npjpcrm
Citation
npj Primary Care Respiratory Medicine, 2016, v. 26, p. 15080:1-6 How to Cite?
AbstractAcute cough is a common reason to prescribe antibiotics in primary care. This study aimed to explore help-seeking and antibiotic prescribing for acute cough in Chinese primary care population. This is a prospective multicentre observational study that included adults presenting with acute cough. Clinicians recorded patients’ presenting symptoms, examination findings and medication prescription. Patients completed symptom diaries for up to 28 days by charting their symptom severity and recovery. Adjusted binary logistic regression models identified factors independently associated with antibiotic prescription. Primary care clinicians (n=19) recruited 455 patients. A total of 321 patients (70.5%) returned their completed symptom diaries. Concern about illness severity (41.6%) and obtaining a prescription for symptomatic medications (45.9%), rather than obtaining a prescription for antibiotics, were the main reasons for consulting. Antibiotics were prescribed for 6.8% (n=31) of patients, of which amoxicillin was the most common antimicrobial prescribed (61.3%), as it was associated with clinicians’ perception of benefit from antibiotic treatment (odds ratio (OR): 25.9, 95% confidence interval (CI): 6.7–101.1), patients’ expectation for antibiotics (OR: 5.1, 95% CI: 1.7–11.6), anticipation (OR: 5.1, 95% CI: 1.6–15.0) and request for antibiotics (OR 15.7, 95% CI: 5.0–49.4), as well as the severity of respiratory symptoms (cough, sputum, short of breath and wheeze OR: 2.7–3.7, all P<0.05). There was a significant difference in antibiotic prescription rates between private primary care clinicians and public primary care clinicians (17.4 vs 1.6%, P=0.00). Symptomatic medication was prescribed in 98.0% of patients. Mean recovery was 9 days for cough and 10 days for all symptoms, which was not significantly associated with antibiotic treatment. Although overall antibiotic-prescribing rates were low, there was a higher rate of antibiotic prescribing among private primary care clinicians, which warrants further exploration and scope for education and intervention.
Persistent Identifierhttp://hdl.handle.net/10722/238660
ISSN
2017 Impact Factor: 2.485
2015 SCImago Journal Rankings: 0.340
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorWong, CKM-
dc.contributor.authorLiu, Z-
dc.contributor.authorButler, CC-
dc.contributor.authorWong, SYS-
dc.contributor.authorFung, A-
dc.contributor.authorChan, D-
dc.contributor.authorYip, BHK-
dc.contributor.authorKung, K-
dc.date.accessioned2017-02-20T01:24:27Z-
dc.date.available2017-02-20T01:24:27Z-
dc.date.issued2016-
dc.identifier.citationnpj Primary Care Respiratory Medicine, 2016, v. 26, p. 15080:1-6-
dc.identifier.issn2055-1010-
dc.identifier.urihttp://hdl.handle.net/10722/238660-
dc.description.abstractAcute cough is a common reason to prescribe antibiotics in primary care. This study aimed to explore help-seeking and antibiotic prescribing for acute cough in Chinese primary care population. This is a prospective multicentre observational study that included adults presenting with acute cough. Clinicians recorded patients’ presenting symptoms, examination findings and medication prescription. Patients completed symptom diaries for up to 28 days by charting their symptom severity and recovery. Adjusted binary logistic regression models identified factors independently associated with antibiotic prescription. Primary care clinicians (n=19) recruited 455 patients. A total of 321 patients (70.5%) returned their completed symptom diaries. Concern about illness severity (41.6%) and obtaining a prescription for symptomatic medications (45.9%), rather than obtaining a prescription for antibiotics, were the main reasons for consulting. Antibiotics were prescribed for 6.8% (n=31) of patients, of which amoxicillin was the most common antimicrobial prescribed (61.3%), as it was associated with clinicians’ perception of benefit from antibiotic treatment (odds ratio (OR): 25.9, 95% confidence interval (CI): 6.7–101.1), patients’ expectation for antibiotics (OR: 5.1, 95% CI: 1.7–11.6), anticipation (OR: 5.1, 95% CI: 1.6–15.0) and request for antibiotics (OR 15.7, 95% CI: 5.0–49.4), as well as the severity of respiratory symptoms (cough, sputum, short of breath and wheeze OR: 2.7–3.7, all P<0.05). There was a significant difference in antibiotic prescription rates between private primary care clinicians and public primary care clinicians (17.4 vs 1.6%, P=0.00). Symptomatic medication was prescribed in 98.0% of patients. Mean recovery was 9 days for cough and 10 days for all symptoms, which was not significantly associated with antibiotic treatment. Although overall antibiotic-prescribing rates were low, there was a higher rate of antibiotic prescribing among private primary care clinicians, which warrants further exploration and scope for education and intervention.-
dc.languageeng-
dc.publisherNature Publishing Group: Open Access Journals - Option C. The Journal's web site is located at http://www.nature.com/npjpcrm-
dc.relation.ispartofnpj Primary Care Respiratory Medicine-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.titleHelp-seeking and antibiotic prescribing for acute cough in a Chinese primary care population: a prospective multicentre observational study-
dc.typeArticle-
dc.identifier.emailKung, K: kkung@hku.hk-
dc.identifier.authorityKung, K=rp01974-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1038/npjpcrm.2015.80-
dc.identifier.hkuros271169-
dc.identifier.volume26-
dc.identifier.spage15080:1-
dc.identifier.epage6-
dc.identifier.isiWOS:000368548000002-
dc.publisher.placeUnited Kingdom-

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