Dowell J, Pitkethly M, Bain J, Martin S
Tayside Centre for General Practice, Kirsty Semple Way, Dundee DD2 4AD.
Br J Gen Pract. 2001 Mar;51(464):200-5.
Despite evidence that uncomplicated lower respiratory tract infection (cough) does not respond appreciably to antibiotics and that bacterial resistance is increasing, general practitioners (GPs) still prescribe frequently.
To assess delayed antibiotic prescribing as a strategy for reducing the unnecessary use of antibiotics for cough in primary care.
Open randomised controlled trial of delayed versus immediate prescribing of antibiotics.
One hundred and ninety-one adult patients with uncomplicated cough in 22 Scottish practices who would have received antibiotics under the GP's usual practice were randomised to receive either an immediate prescription (92 patients) or a delayed prescription (99 patients).
Delayed subjects were asked to wait a week before deciding whether to collect their prescription. Outcome measures included symptom duration, prescription uptake, patient satisfaction, patient enablement, and subsequent consultation rates. The 48 GPs who recruited patients were surveyed six months after the trial to see whether they used delayed prescribing as a part of their normal practice.
Study and control groups were similar at baseline. Of the subjects in the delayed arm, 55% did not pick up their prescription. Although most patients were satisfied, more patients in the immediate arm were very satisfied with the treatment (P = 0.001) and the consultation (P = 0.03). The patients in the immediate arm were also more enabled (3.3 versus 2.4; P = 0.04), although more of them intended to consult for similar complaints in the future (85% versus 69%, P = 0.02). We were unable to detect any difference in actual consulting behaviour in the follow-up period (mean = 15 months [SD = 5 months]). Subsequently, 68% of GPs used delayed prescribing at least monthly; all gave the prescription to the patient.
Delayed prescribing is effective at reducing the use of antibiotics for self-limiting cough; however, patients are less satisfied and enabled as a result. Patients may be deterred from consulting rather than becoming enabled.
尽管有证据表明单纯性下呼吸道感染（咳嗽）对抗生素并无明显反应，且细菌耐药性不断增加，但全科医生（GP）仍频繁开具抗生素处方。
评估延迟开具抗生素处方作为减少基层医疗中咳嗽患者不必要使用抗生素的一种策略。
抗生素延迟处方与立即处方的开放随机对照试验。
苏格兰22家诊所的191例患有单纯性咳嗽的成年患者，这些患者在全科医生的常规诊疗中本会接受抗生素治疗，被随机分为立即处方组（92例患者）或延迟处方组（99例患者）。
延迟组患者被要求等待一周后再决定是否领取处方。观察指标包括症状持续时间、处方领取情况、患者满意度、患者自主能力以及后续就诊率。招募患者的48位全科医生在试验6个月后接受调查，以了解他们是否将延迟处方作为其常规诊疗的一部分。
研究组和对照组在基线时相似。延迟组中55%的患者未领取处方。尽管大多数患者表示满意，但立即处方组中更多患者对治疗（P = 0.001）和诊疗（P = 0.03）非常满意。立即处方组的患者自主能力也更强（3.3对2.4；P = 0.04），不过他们中更多人打算未来因类似症状再次就诊（85%对69%，P = 0.02）。我们在随访期（平均15个月[标准差 = 5个月]）未发现实际就诊行为有任何差异。随后，68%的全科医生至少每月使用一次延迟处方；所有医生都将处方给了患者。
延迟处方在减少自限性咳嗽抗生素使用方面有效；然而，患者满意度和自主能力会因此降低。患者可能会因延迟处方而不愿就诊，而非更愿意就诊。
