School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, China.
School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.
NPJ Prim Care Respir Med. 2021 Mar 25;31(1):17. doi: 10.1038/s41533-021-00229-9.
This study aimed to determine the association between factors relevant to diagnostic uncertainty and physicians' antibiotic-prescribing behaviour in primary care. A questionnaire survey was conducted on 327 physicians that measured their diagnostic ability, perceived frequency of diagnostic uncertainty, tolerance, and perceived patient tolerance of uncertainty. Physician antibiotic-prescribing behaviours were assessed based on their prescriptions (n = 207,804) of three conditions: upper respiratory tract infections (URTIs, antibiotics not recommended), acute tonsillitis (cautious use of antibiotics), and pneumonia (antibiotics recommended). A two-level logistic regression model determined the association between diagnostic uncertainty factors and physician antibiotic prescribing. Physicians perceived a higher frequency of diagnostic uncertainty resulting in higher antibiotic use for URTIs and less antibiotic use for pneumonia. Higher antibiotic use for acute tonsillitis was related to a low tolerance of uncertainty of physicians and patients. This study suggests that reducing diagnostic uncertainty and improving physician and patient uncertainty management could reduce antibiotic use.
本研究旨在确定与诊断不确定性相关的因素与初级保健医生抗生素处方行为之间的关联。对 327 名医生进行了问卷调查，以衡量他们的诊断能力、感知诊断不确定性的频率、容忍度以及感知患者对不确定性的容忍度。根据他们对三种情况的处方（URTI[抗生素不推荐]、急性扁桃体炎[谨慎使用抗生素]和肺炎[推荐使用抗生素]）评估医生的抗生素处方行为。采用两水平逻辑回归模型确定诊断不确定性因素与医生抗生素处方之间的关联。医生感知到更高的诊断不确定性频率导致对 URTI 的抗生素使用更高，对肺炎的抗生素使用更少。对急性扁桃体炎的抗生素使用更多与医生和患者对不确定性的容忍度低有关。本研究表明，减少诊断不确定性和改善医生和患者的不确定性管理可以减少抗生素的使用。
