Lee Magdalene Hui Min, Pan Darius Shaw Teng, Huang Joyce Huixin, Chen Mark I-Cheng, Chong Joash Wen Chen, Goh Ee Hui, Jiang Lili, Leo Yee Sin, Lee Tau Hong, Wong Chia Siong, Loh Victor Weng Keong, Lim Fong Seng, Poh Adrian Zhongxian, Tham Tat Yean, Wong Wei Mon, Yu Yue
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Saw Swee Hock School of Public Health, National University of Singapore, Singapore
Antimicrob Agents Chemother. 2017 Apr 24;61(5). doi: 10.1128/AAC.02257-16. Print 2017 May.
We investigated the efficacy of patient-targeted education in reducing antibiotic prescriptions for upper respiratory tract infections (URTIs) among adults in the private primary care setting in Singapore. Our randomized controlled trial enrolled patients aged 21 years and above presenting at general practitioner (GP) clinics with URTI symptoms for 7 days or less. Intervention arm patients were verbally educated via pamphlets about the etiology of URTIs, the role of antibiotics in treating URTIs, and the consequences of inappropriate antibiotic use. Control arm patients were educated on influenza vaccinations. Both arms were compared regarding the proportions prescribed antibiotics and the patients' postconsultation views. A total of 914 patients consulting 35 doctors from 24 clinics completed the study (457 in each arm). The demographics of patients in both arms were similar, and 19.1% were prescribed an antibiotic, but this varied from 0% to 70% for individual GPs. The intervention did not significantly reduce antibiotic prescriptions (odds ratio [OR], 1.20; 95% confidence interval [CI], 0.83-1.73) except in patients of Indian ethnicity (OR, 0.28; 95% CI, 0.09-0.93). Positive associations between the intervention and the view that antibiotics were not needed most of the time for URTIs ( = 0.047) and on being worried about the side effects of antibiotics ( = 0.018) were restricted to the Indian subgroup. GPs in limited liability partnerships or clinic chains prescribed less (OR, 0.36; 95% CI, 0.14 to 0.92), while certain inappropriate patient responses were associated with the receipt of antibiotics. Follow-up studies to investigate differences in responses to educational programs between ethnicities and to explore GP-targeted interventions are recommended.
我们调查了以患者为目标的教育在减少新加坡私立基层医疗环境中成人上呼吸道感染（URTI）抗生素处方方面的效果。我们的随机对照试验纳入了年龄在21岁及以上、因URTI症状在全科医生（GP）诊所就诊7天及以内的患者。干预组患者通过宣传册接受了关于URTI病因、抗生素在治疗URTI中的作用以及不当使用抗生素后果的口头教育。对照组患者接受了流感疫苗接种方面的教育。比较了两组患者开具抗生素的比例以及患者咨询后的看法。共有来自24家诊所的914名咨询35名医生的患者完成了研究（每组457名）。两组患者的人口统计学特征相似，19.1%的患者开具了抗生素，但个别全科医生的比例从0%到70%不等。除了印度裔患者（比值比[OR]，0.28；95%置信区间[CI]，0.09 - 0.93）外，该干预措施并未显著减少抗生素处方（比值比[OR]，1.20；95%置信区间[CI]，0.83 - 1.73）。干预措施与认为大多数时候URTI不需要使用抗生素（P = 0.047）以及担心抗生素副作用（P = 0.018）之间的正相关关系仅限于印度亚组。有限责任合伙制或连锁诊所的全科医生开具的抗生素较少（比值比[OR]，0.36；95%置信区间[CI]，0.14至0.92），而某些不适当的患者反应与接受抗生素治疗有关。建议进行后续研究，以调查不同种族对教育项目反应的差异，并探索针对全科医生的干预措施。
