Determinants of initiation, implementation, and discontinuation of amoxicillin by adults with acute cough in primary care
Gillespie, David; Farewell, Daniel; Brookes-Howell, Lucy; Butler, Christopher C.; Coenen, Samuel; Francis, Nick A.; Little, Paul; Stuart, Beth; Verheij, Theo; Hood, Kerenza; GRACE Consortium
(2017) Patient Preference and Adherence, volume 11, pp. 561 - 569
(Article)
Abstract
Aim: To investigate the determinants of adherence to amoxicillin in patients with acute lower respiratory tract infection. Materials and methods: Three European data sets were used. Adherence data were collected using self-reported diaries. Candidate determinants included factors relating to patient, condition, therapy, health care system/provider, and the study in which
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the patient participated. Logistic and Cox regression models were used to investigate the determinants of initiation, implementation, and discontinuation of amoxicillin. Results: Although initiation differed across samples, implementation and discontinuation were similar. Determinants of initiation were days waited before consulting, duration of prescription, and being in a country where a doctor-issued sick certificate is required for being off work for 7 days. Implementation was higher for older participants or those with abnormal auscultation. Implementation was lower for those prescribed longer courses of amoxicillin (≥8 days). Time from initiation to discontinuation was longer for longer prescriptions and shorter for those from countries where single-handed practices were widespread. Conclusion: Nonadherence to amoxicillin was largely driven by noninitiation. Differing sets of determinants were found for initiation, implementation, and discontinuation. There is a need to further understand the reasons for these determinants, the impact of poor adherence to antibiotics on outcomes, and to develop interventions to improve antibiotic use when prescribed.
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Keywords: Adherence, Antibiotics, Determinants, General practice, Medicine (miscellaneous), Social Sciences (miscellaneous), Pharmacology, Toxicology and Pharmaceutics (miscellaneous), Health Policy
ISSN: 1177-889X
Publisher: Dove Medical Press Ltd.
Note: Funding Information: The authors wish to acknowledge Professor Herman Goossens and Ms Jacqueline Nuttall for helping shape the manuscript. In addition, we would like to acknowledge the entire GRACE consortium for their tremendous efforts, both directly and indirectly, in shaping the work presented in this manuscript, including Tricia Worby, Alicia Borras, An De Sutter, Anna Kowalczyk, Antoni Torres, Artur Mierzecki, Bernadette Kovaks, Bo-Eric Malmvall, Carol Pascoe, Christina Lannering, Christine Lammens, Curt Brugman, Francesco Blasi, Frank Leus, Greet Ieven, Helena Hupkova, Igor Svab, Iris Hering, Jackie Swain, Janko Kersnik, Jo Coast, Jordi Almirall, Judit Holczerné, Karel Moons, Katherine Loens, Kirsi Valve, Kristien Dirven, Kristin Alise Jakobsen, Lidewij Broekhuizen, Maciek Godycki-Cwirko, Magdalena Muras, Margareta Ieven, Marieke Lemiengre, Matteu Serra, Mel Davies, Michael Moore, Niels Adriaenssens, Nuria Sanchez Romano, Paolo Tarsia, Pascale Bruno, Patricia Fernez, Peter Edwards, Peter Zuithoff, Pia Touboul, Pim de Jong, Richard Smith, Robert Veen, Saskia van Vugt, Sigvard Mölstad, Slawomir Chlabicz, Tom Schaberg, Zuzana Bielicka, and Zseraldina Arvai. Funding The GRACE consortium’s research was funded by the European Community’s Sixth Framework Programme (grant agreement 518226). Work in the UK was also supported by the National Institute for Health Research, in Barcelona by 2009 SGR 911 Ciber de Enfermedades Respiratorias (Ciberes CB06/06/0028), and in Belgium by the Research Foundation – Flanders (FWO; G.0274.08N). The work reported on in this publication has been financially supported by Bond University (Australia), Research Foundation – Flanders, University of Antwerp, University of Ghent (Belgium), Chinese University of Hong Kong (People’s Republic of China), University of Copenhagen (Denmark), Research Council of Health, Academy of Finland (Finland), College Azuréen des Généralistes Enseignants, Comité Départemental d’Education pour la Santé (France), Rostock University (Germany), the Netherlands Organisation for Scientific Research, AMC Amsterdam, Leiden UMC, UMC Utrecht (the Netherlands), Research Council of Norway, University of Oslo, University of Tromso (Norway), Medical University of Bialystok, Medical University of Lodz (Poland), National University Research Council (Romania), Osnovno zdravstvo Gorenjske (Slovenia), l’Institut d’Investigacions Biomèdiques August Pi i Sunyer (Spain), Swedish Research Council, Karolinska Institute (Sweden), Medical Research Council, Cardiff University, University of Oxford, University of Southampton (United Kingdom), Swiss National Science Foundation (Switzerland) through the European Science Foundation (ESF), in the framework of the Research Networking Programme TRACE (http://archives.esf.org/trace). Publisher Copyright: © 2017 Gillespie et al.
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