Abstract
PURPOSE
To determine to what extent patient expectations regarding the need for antibiotics for upper respiratory tract infection symptoms were associated with receiving antibiotics.
METHODS
Adult patients complaining of symptoms suggestive of upper respiratory tract infection completed a questionnaire before being seen by a health care provider at the walk-in clinic of an inner-city teaching hospital. They were asked about symptoms, prior antibiotic use for similar symptoms, and how strongly they felt they needed an antibiotic for their symptoms ("definitely," "probably," "maybe," "probably not" or "definitely not"). The subjects' charts were subsequently reviewed to determine whether or not they had been prescribed antibiotics. A Chi Square statistic was used to detect differences between the groups.
RESULTS
200 subjects completed the questionnaire. Demographic characteristics of the study population were a mean age of 35 years, 50% Caucasian, 57% male, 53% uninsured, and 21% with a degree higher than a high school diploma. 52% of the subjects received antibiotics at this visit. Antibiotic prescribing rates varied in relation to how strongly the subjects felt they needed antibiotics. 61% of those responding "definitely" were prescribed an antibiotic compared to 53% of those responding "probably," 40% responding "maybe" and 29% responding "probably not" or "definitely not" (p = .048). Patients with an Associates Degree or higher received antibiotics 56% of the time, while those with less than a high school education received them only 27% of the time (p = .02). Both groups were equally likely to think they needed antibiotics. There was no significant association between gender and receiving antibiotics. Although race was not associated with how strongly patients believed they needed antibiotics, Caucasians were slightly more likely to receive them than non-Caucasians (55% vs 47%, p = .06 NS). However, comparing the combined group of Caucasians and African-Americans to other minorities—primarily Native Americans, Hispanics and native-born Africans—there was a marked difference in antibiotic prescription rates (55% vs 31% p = .02).
CONCLUSION
In this patient population, expectations regarding the need for antibiotics, education level, and race were each significantly associated with receiving antibiotics for upper respiratory tract infections. Gender was not associated with antibiotic prescription rates.