van Driel Mieke L, De Sutter An, Deveugele Myriam, Peersman Wim, Butler Christopher C, De Meyere Marc, De Maeseneer Jan, Christiaens Thierry
Department of General Practice and Primary Health Care, Ghent University, De Pintelaan 185, UZ-1K3, B-9000 Ghent, Belgium.
Ann Fam Med. 2006 Nov-Dec;4(6):494-9. doi: 10.1370/afm.609.
Antibiotics are still overprescribed for self-limiting upper respiratory tract infections such as acute sore throat, and physicians mention patient's desire for antibiotics as a driving force. We studied patients' concerns when visiting their family physician for acute sore throat, more specifically the importance they attach to antibiotic treatment and pain relief.
Family physicians in 6 peer groups in Belgium participated in an observational postvisit questionnaire survey. Patients aged 12 years and older making an office visit for acute sore throat were invited to indicate the importance of different reasons for the visit.
Sixty-eight family physicians provided data from 298 patients. The 3 most frequently endorsed reasons for visiting the physician were examination to establish the cause of the symptoms, pain relief, and information on the course of the disease. Hopes for an antibiotic ranked 11th of 13 items. Patients who considered antibiotics very/rather important valued pain relief significantly more than patients who considered them little/not important (P <.001). Patients who hoped for antibiotics felt more unwell (P <.001), had more faith in antibiotics to speed recovery (P <.001), and were less convinced that sore throat was a self-limiting disease (P <.012). A multivariate model, adjusted for age, sex, and educational status, showed that the desire for pain relief is a strong predictor of the hope to receive a prescription for antibiotics.
Our study suggests that patients with acute sore throat and who hope for antibiotics may in fact want treatment for pain. Trials are needed to test whether exploring patients' expectations about pain management and offering adequate analgesia can assist physicians in managing sore throats without prescribing antibiotics.
抗生素在治疗如急性咽痛等自限性上呼吸道感染时仍存在过度开具的情况,医生提到患者对抗生素的需求是一个推动因素。我们研究了患者因急性咽痛就诊于家庭医生时的担忧,更具体地说是他们对抗生素治疗和缓解疼痛的重视程度。
比利时6个同行小组的家庭医生参与了一项就诊后观察性问卷调查。邀请12岁及以上因急性咽痛前来门诊就诊的患者指出就诊不同原因的重要性。
68名家庭医生提供了298名患者的数据。就诊最常被认可的3个原因是检查以确定症状原因、缓解疼痛以及了解疾病病程。对抗生素的期望在13项中排名第11。认为抗生素非常/比较重要的患者比认为抗生素不太/不重要的患者更重视疼痛缓解(P<.001)。希望使用抗生素的患者感觉更不适(P<.001),更相信抗生素能加速康复(P<.001),并且不太相信咽痛是自限性疾病(P<.012)。一个根据年龄、性别和教育程度进行调整的多变量模型显示,对疼痛缓解的需求是希望获得抗生素处方的有力预测因素。
我们的研究表明,患有急性咽痛且希望使用抗生素的患者实际上可能是想要缓解疼痛的治疗。需要进行试验来测试,探究患者对疼痛管理的期望并提供充分的镇痛措施是否能帮助医生在不开具抗生素的情况下处理咽痛。