Role of patients' and doctors' views on the management of respiratory tract infections

Abstract

The vast majority of respiratory tract (RT) symptoms such as cough, sore throat and earache are self-limiting (viral) infections. Despite this self-limiting character, in the Netherlands antibiotics are prescribed in about one out of every three RT episodes. A further rationalisation of antibiotic use by GPs is indicated, while inappropriate prescribing of antibiotics yields risk of side-effects, unnecessary utilisation of health services, encouraging patients to re-consult their GP for subsequent RT episode, and development of antimicrobial resistance. It is well established that a patient's decision to contact the GP, and the GP's management decisions are influenced by both the patients' and the GPs' views and by the way in which patients and GPs communicate with each other. A better insight in patients' and GPs' views might be fruitful to target implementation strategies and quality assurance programmes to improve antimicrobial management in general practice. The main focus of the studies presented in this thesis was to explore patients' and GPs' views on RT symptoms and antibiotics as possible determinants (amongst others) of illness behaviour, antibiotic prescribing, and international differences in outpatient antibiotic use. This thesis has shown that patients' views play a role in RT episodes. Therefore, it is important that the GP explores patient's views to avoid misinterpretation and to enhance shared decision making. Next to this,0020patients' views probably support their GPs' decision to prescribe antibiotics. This thesis also showed that GP's views are important in the management of RT episodes; GPs have to be aware that neither a single inflammation sign nor smoking by itself are sufficient reason to prescribe antibiotics in case of RT symptoms. The finding that the tendency to label RT episodes as infections is a determinant of the volume of antibiotics prescribed for RT episodes might indicate that diagnostic labelling is influenced by reasons of therapeutic justification. GPs should label RT episodes as infections when any type of infection is suspected, realising that only a minor proportion of all RT infections do warrant antimicrobial therapy. The inclination of GPs to prescribe new drugs is associated with the volume of second-choice antibiotics. Since this tendency is strongly correlated with receiving visits from pharmaceutical representatives, GPs should avoid visits from these representatives in the practice. GPs might be less concerned about patient dissatisfaction if they do not prescribe antibiotics; taking patients seriously will probably more benefit satisfaction. More consensus is needed between practice assistants' and GPs' views in order to enhance uniform disease management among practices. To achieve this, quality assurance programs might help to increase consensus and mutual understanding between GPs and practice. Finally, this thesis showed that international differences in outpatient antibiotic use can only partially be explained by differences in patients' views. Exploration of other possible determinants indicates that being more directly dependent on patients for income might be a risk factor for higher outpatient antibiotic use prescribed by GPs, while a higher degree of professional influence might be a moderating factor.