Antibiotic Center for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, PO Box 1130 Blindern, N-0318 Oslo, Norway.
BMC Fam Pract. 2011 May 18;12:34. doi: 10.1186/1471-2296-12-34.
BACKGROUND: Delayed prescribing of antibiotics for respiratory tract infections (RTIs) lowers the amount of antibiotics consumed. Several national treatment guidelines on RTIs recommend the strategy. When advocating treatment innovations, the feasibility and credibility of the innovation must be taken into account. The objective of this study was to explore GPs use and patients uptake of wait-and-see prescriptions for RTIs, and to investigate the feasibility of the strategy from GPs' and patients' perspectives. METHODS: Questionnaire survey among Norwegian GPs issuing and patients receiving a wait-and-see-prescription for RTIs. Patients reported symptoms, confidence and antibiotics consumption, GPs reported diagnoses, reason for issuing a wait-and-see-prescription and their opinion about the method. RESULTS: 304 response pairs from consultations with 49 GPs were received. The patient response rate was 80%. The most common diagnosis for the GPs to issue a wait-and-see prescription was sinusitis (33%) and otitis (21%). 46% of the patients reported to consume the antibiotics. When adjusted for other factors, the diagnosis did not predict antibiotic consumption, but both being 16 years or more (p = 0,006) and reporting to have a fever (p = 0,012) doubled the odds of antibiotic consumption, while feeling very ill more than quadrupled the odds (p = 0,002). In 210 cases (69%), the GP found delayed prescribing a very reasonable strategy, and 270 patients (89%) would prefer to receive a wait-and-see prescription in a similar situation in the future. The GPs found delayed prescribing very reasonable most frequently in cases of sinusitis (79%, p = 0,007) and least frequently in cases of lower RTIs (49%, p = 0,002). CONCLUSION: Most patients and GPs are satisfied with the delayed prescribing strategy. The patients' age, symptoms and malaise are more important than the diagnosis in predicting antibiotic consumption. The GP's view of the method as a reasonable approach depends on the patient's diagnosis. In our setting, delayed prescribing seems to be a feasible strategy, especially in cases of sinusitis and otitis. Educational efforts to promote delayed prescribing in similar settings should focus on these diagnoses.
背景：延迟开具抗生素处方可减少抗生素的使用量。多项关于呼吸道感染的国家治疗指南都推荐这一策略。在倡导治疗创新时，必须考虑创新的可行性和可信度。本研究旨在探讨全科医生开具和患者接受呼吸道感染静观等待处方的情况，并从全科医生和患者的角度调查该策略的可行性。
方法：对开具和接受呼吸道感染静观等待处方的挪威全科医生进行问卷调查。患者报告症状、信心和抗生素使用情况，全科医生报告诊断、开具静观等待处方的原因以及对该方法的看法。
结果：共收到 49 名全科医生开具的 304 对咨询的回复。患者的回复率为 80%。全科医生最常开出静观等待处方的诊断是鼻窦炎（33%）和中耳炎（21%）。46%的患者报告使用了抗生素。调整其他因素后，诊断并不能预测抗生素的使用，但年龄在 16 岁及以上（p=0.006）和报告发热（p=0.012）的患者使用抗生素的几率会翻倍，而感到非常不适的患者使用抗生素的几率会增加四倍（p=0.002）。在 210 例（69%）中，全科医生认为延迟开具处方是一种非常合理的策略，270 名患者（89%）在类似情况下更愿意接受静观等待处方。全科医生认为在鼻窦炎病例中延迟开具处方非常合理（79%，p=0.007），而在较低的呼吸道感染病例中最不合理（49%，p=0.002）。
结论：大多数患者和全科医生对延迟开具处方的策略感到满意。患者的年龄、症状和不适比诊断更能预测抗生素的使用。全科医生认为该方法合理的程度取决于患者的诊断。在我们的环境中，延迟开具处方似乎是一种可行的策略，尤其是在鼻窦炎和中耳炎的情况下。在类似环境中推广延迟开具处方的教育工作应侧重于这些诊断。
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