降低上呼吸道感染患者对抗生素的期望：一项初级保健随机对照试验。
Reducing Expectations for Antibiotics in Patients With Upper Respiratory Tract Infections: A Primary Care Randomized Controlled Trial.
机构信息
Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand.
出版信息
Ann Fam Med. 2021 May-Jun;19(3):232-239. doi: 10.1370/afm.2672.
PURPOSE
Many family practitioners prescribe antibiotics for patients with upper respiratory tract infections (URTIs) to meet patients' expectations. We evaluated the impact of providing brief tablet-based information about antibiotic treatment of URTIs on patients' expectations for antibiotics and on family practitioners' antibiotic-prescribing behavior.
METHODS
We performed a 3-arm randomized controlled trial among patients presenting with URTIs at 2 urban family practices in Auckland, New Zealand, during winter 2018. Participants were randomly allocated to view a presentation about the futility of antibiotic treatment of URTIs, the adverse effects associated with antibiotics, or the benefits of healthy diet and exercise (active control), immediately before their consultation. Before and after viewing the presentations, participants used a Likert scale to rate the strength of their belief that antibiotics are effective for treating URTIs and of their desire to be prescribed an antibiotic. Patients reported whether an antibiotic had been prescribed, and pharmacy dispensing records were reviewed to determine whether an antibiotic was dispensed.
RESULTS
Participants who viewed either the futility or the adverse effects presentation had greater reductions in their expectations to receive antibiotics than the control group. The mean reduction (95% CI) was 1.1 (0.8-1.3) for the futility group, 0.7 (0.4-0.9) for the adverse effects group, and 0.1 (0-0.3) for the control group (Cohen = 0.7; <.001). There was no significant difference among the 3 groups with regard to antibiotic prescribing ( = .84) or dispensing ( = .43).
CONCLUSIONS
A brief tablet-based waiting room intervention significantly reduced participants' expectations about receiving antibiotics for URTI immediately before their family practitioner consultation. The intervention did not influence family practitioner prescribing behavior, however.
目的
许多家庭医生为上呼吸道感染 (URTI) 患者开抗生素，以满足患者的期望。我们评估了提供关于 URTI 抗生素治疗的简短基于平板电脑的信息对患者对抗生素的期望以及对家庭医生开抗生素处方行为的影响。
方法
我们在新西兰奥克兰的 2 家城市家庭实践中进行了一项 3 臂随机对照试验，在 2018 年冬季期间，URTI 患者参与了试验。参与者被随机分配在就诊前立即观看有关抗生素治疗 URTI 无效性、抗生素相关副作用或健康饮食和运动益处的演示（主动对照组）。在观看演示前后，参与者使用李克特量表评估他们对抗生素治疗 URTI 的有效性的信念强度以及他们想要开抗生素的愿望。患者报告是否开了抗生素，并且查看了药房配药记录以确定是否开出了抗生素。
结果
与对照组相比，观看无效或副作用演示的参与者对抗生素的期望降低幅度更大。无效组的平均减少量（95%CI）为 1.1（0.8-1.3），副作用组为 0.7（0.4-0.9），对照组为 0.1（0-0.3）（Cohen = 0.7；<.001）。3 组间抗生素处方（=0.84）或配药（=0.43）无显著差异。
结论
在家庭医生就诊前，简短的基于平板电脑的候诊室干预显著降低了参与者对接受 URTI 抗生素治疗的期望。然而，该干预并未影响家庭医生的处方行为。
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