患者对上呼吸道感染的认知：对抗生素期望及不必要使用的影响

Patient knowledge of upper respiratory infections: implications for antibiotic expectations and unnecessary utilization.

作者信息

Mainous A G, Zoorob R J, Oler M J, Haynes D M

机构信息

Department of Family Practice, University of Kentucky, Lexington 40536-0284, USA.

出版信息

J Fam Pract. 1997 Jul;45(1):75-83.

PMID:9228917

Abstract

BACKGROUND

Upper respiratory infections (URIs) account for many of the visits in primary care and are commonly treated with ineffective antibiotic therapy. The purpose of this study was to examine patient beliefs in the effectiveness of antibiotics and the likelihood of seeking care for normal presentations of URIs.

METHODS

We conducted a survey of 961 adults (> or = 18 years of age) from an undifferentiated patient population in a university-based family practice residency clinic in metropolitan Kentucky, a private internal medicine practice in nonmetropolitan Kentucky, and, in metropolitan Louisiana, an emergency department and a convenience sample from the community.

RESULTS

Seventy-two percent of the sample reported that they would seek care with a condition of 5 days' duration with cough, sore throat, and discolored nasal discharge. Sixty-one percent of the sample expressed their belief that antibiotics are effective for a condition of 5 days' duration with cough, sore throat, and clear nasal discharge; 79% said that they believed antibiotics are effective when there is discolored discharge (P = .0001). Medicaid recipients were most likely to seek care across the symptom complexes. Higher education was related to a decreased belief in the effectiveness of antibiotics for the scenario with clear discharge (P .001), but to an increased belief in the effectiveness of antibiotics in the scenario with discolored discharge (P = .003). The strongest predictor of both likelihood of utilization and belief in effectiveness of antibiotics was usual use of antibiotics for the URI symptom complexes.

CONCLUSIONS

Patients lack understanding of the normal presentation of a URI and the effectiveness of antibiotics as a treatment. A confusion about the meaning of discolored nasal discharge is particularly evident, and past antibiotic use may contribute to inappropriate utilization and expectations for antibiotics.

摘要

背景

上呼吸道感染（URIs）是基层医疗中患者就诊的常见原因，通常采用无效的抗生素治疗。本研究的目的是调查患者对抗生素有效性的看法以及因上呼吸道感染正常症状而寻求治疗的可能性。

方法

我们对来自肯塔基州大都市一家大学附属家庭医疗住院诊所的961名未分化成年患者（≥18岁）、肯塔基州非大都市地区的一家私人内科诊所、路易斯安那州大都市地区的一家急诊科以及社区便利样本进行了调查。

结果

72%的样本表示，他们会因咳嗽、喉咙痛和鼻涕变色等持续5天的症状而寻求治疗。61%的样本认为抗生素对咳嗽、喉咙痛和清鼻涕持续5天的症状有效；79%的人表示，他们认为有鼻涕变色时抗生素有效（P = 0.0001）。医疗补助接受者在各种症状组合中最有可能寻求治疗。高等教育与对清鼻涕情况下抗生素有效性的信念降低有关（P < 0.001），但与鼻涕变色情况下抗生素有效性的信念增加有关（P = 0.003）。抗生素使用可能性和有效性信念的最强预测因素是上呼吸道感染症状组合通常使用抗生素。