Table 1.
Characteristics of included studies
| Reference | Country and setting | No and age of participants* | Condition | Intervention and comparison group | Type of delay | Outcome | Funding source | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| SS | SD | R | C | PS | |||||||
| Randomised controlled trials | |||||||||||
| Little 1997 | UK, primary care | 716; 25.3 (17.0) | Sore throat | None, immediate, delayed | Prescription to be filled if symptoms did not start to settle after 3 days | + | + | + | + | − | Wessex NHS |
| Little 2001 | UK, primary care | 315; 5.0 (2.8) | Acute otitis media | None, immediate, delayed | Prescription collected after 72 hours if child still not improving | + | + | + | + | + | NHS R&D |
| Arroll 2002 | New Zealand, primary care | 129; 25.6 (23.0) | Common cold | Immediate, delayed | Prescription to be filled after 3 days if symptoms fail to improve | − | + | − | − | + | NZ Health Research Council |
| McCormick 2005 | USA, paediatric clinic | 223; 2.7 (2.7) | Acute otitis media | None, delayed | No antibiotics unless returning with acute ear symptoms within 30 days | + | + | + | + | + | US National Institutes of Health |
| Little 2005 | UK, primary care | 807; 39 (20.8) | Lower respiratory tract infection | None, immediate, delayed | Prescription to be filled if symptoms not resolved after 4 days | + | + | + | + | − | Medical Research Council |
| Chao 2008 | USA, paediatric emergency department | 232; 5.1 (2.4) | Acute otitis media | None, delayed | Advised to fill prescription if symptoms did not resolve in 2-3 days | − | + | + | − | + | NR |
| Little 2014 | UK, primary care | 889; 31.0 (21.2) | Acute respiratory tract infection | None, delayed | Four types: recontact, postdated, collection, patient led | + | + | + | + | + | National Institute for Health Research |
| De La Poza Abad 2016 | Spain, primary care | 405; 44.9 (16.6) | Acute respiratory tract infection | None, immediate, delayed | Collection or patient led if symptoms did not start to improve after a few days | + | + | + | + | + | Spanish Ministry of Health |
| Mas-Dalmau 2021 | Spain, primary care | 437; 6.3 (3.1) | Acute respiratory tract infection | None, immediate, delayed | Collection or patient led if symptoms did not start to improve after a few days | + | + | + | + | + | Spanish Ministry of Health |
| Observational cohort studies | |||||||||||
| Butler, Francis et al 2012 | 13 European countries, primary care network | 2690; 47.8 (16.3) | Cough or lower respiratory tract infection | None, immediate, delayed | Advised to fill if symptoms did not start to improve after 2-7 days | + | + | + | + | + | European Commission; National Institute for Health Research; Research Foundation-Flanders |
| Little 2013 | UK, primary care | 12 626; 34.0 (14.6) | Sore throat | None, immediate, delayed | Patient led | + | + | + | + | − | Medical Research Council; National Institute for Health Research |
| Little 2017 | UK, primary care | 28 856; 51.7 (17.9) | Acute lower respiratory tract infection | None, immediate, delayed | Advised to fill if symptoms did not start to improve; median advised delay=3 days | − | − | + | + | − | National Institute for Health Research |
| Hay 2016 | UK, primary care | 8320; 3.9 (3.7) | Acute cough and respiratory tract infection | None, immediate, delayed | Advised to fill if symptoms did not start to improve; median advised delay=3 days | + | + | + | + | − | National Institute for Health Research |
| Studies for which individual patient data unavailable | |||||||||||
| Pichichero 1987 | USA, paediatric clinic | 114; 7.5 (2.6); 7.8 (2.3) | Sore throat | Immediate, delayed | No detail | + | + | + | − | − | RobertWood Johnson Foundation, Eli Lilly & Co, and Elmwood Paediatric Research fund |
| Gerber 1990 | USA, paediatric clinic | 113; NR | Sore throat | Immediate, delayed | No detail | + | − | − | − | − | NR |
| El-Daher 1991 | Jordan, paediatric clinic | 229; 7.8 (0.23); 8.3 (0.24) | Sore throat | Immediate, delayed | No detail | + | − | − | − | − | Biochemie GmbH and Jordan University of Science and Technology |
| Dowell 2001 | UK, primary care | 191; 41.6 | Cough | Immediate, delayed | Patient to pick up prescription after 1 week of delay | − | + | + | − | + | Royal College of General Practitioners |
| Spiro 2006 | USA, emergency department | 283; 3.2 | Acute otitis media | Immediate, delayed | No detail | − | + | − | − | − | US National Institutes of Health and Yale University School of Medicine |
| Siegel 2003 | USA, paediatric clinic | 194; 5 | Acute otitis media | Immediate, delayed | To be filled only if symptoms did not improve within 2 days | − | − | − | − | − | Whitehall-Robins Healthcare |
| Marchetti 2005 | Italy, primary care | 1672; 4.8 | Acute otitis media | Immediate, delayed | No detail | − | − | − | − | − | NR |
| Fischer 2009 | USA, emergency department | 144; NR | Acute otitis media | Immediate, delayed | To be filled only if symptoms did not improve within 2 days | − | − | − | − | − | NR |
| Kavanagh 2011 | Ireland, primary care | 120; 47.6 (16.3); 48 (17.8) | Acute cough or sore throat | Immediate, delayed | No detail | − | − | + | − | + | WestREN, MSD |
C=complication; NR=nor reported; PS=patient satisfaction; R=reconsultation; SD=symptom duration; SS=symptom severity.
*
Mean (standard deviation).