Statements about Antibiotic Side-Effects and Patient Desire for Unnecessary Antibiotics

From the 2019 HVPAA National Conference

Mr. Benjamin Miller (Johns Hopkins University School of Medicine), Ms. Kathryn Carson (Johns Hopkins Bloomberg School of Public Health), Dr. Sujay Pathak (Johns Hopkins Community Physicians), Dr. Sara Keller (Johns Hopkins School of Medicine)

Background

Antibiotic resistance is a global health emergency fueled in part by non-indicated use of antibiotics. Current public education campaigns primarily focus on the risks of global antibiotic resistance or society-wide adverse impacts of antibiotic misuse. There has been little research into what messages have the greatest impact on patient requests for non-indicated antibiotics.

Methods

We administered a survey at a primary care clinic in August 2018. Participants rated 18 statements about potential harm from antibiotics on how that statement changed their likelihood to request antibiotics for an upper respiratory tract infection (URI) on a 11-point Likert scale. These included 8 statements about potential harm to the individual, 4 statements about potential harm to contacts of the individual, and 6 statements about resistance or the societal impact of antibiotic misuse. Before and after the survey, participants rated how likely they were to request antibiotics for a URI.

Results

Of 1150 adult patients in clinic over the six days of the survey, 250 completed the survey. Statements about potential harm to the individual decreased patient likelihood to request antibiotics more than statements about societal impacts of antibiotic misuse. (p< 0.001). Statements about potential harm to contacts of the patient also decreased patient likelihood to request antibiotics more than statements about resistance or societal impacts of antibiotic misuse (p< 0.001). Statements discussing antibiotic resistance were less likely to impact patient likelihood to request antibiotics than statements not mentioning antibiotic resistance (p< 0.001). All statements decreased patient likelihood to request antibiotics. Overall likelihood to request antibiotics decreased after the survey (from 5.3 pre- to 3.1 post-survey, p< 0.001).

Conclusion

Statements about how potential harm of antibiotics to the individual had a greater impact than statements about resistance or societal impact of antibiotics. Our results suggest that when dissuading patients from requesting non-indicated antibiotics, providers and public health campaigns focus on the potential harm of antibiotics to the individual patient rather than on antibiotic resistance or societal impacts.

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