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Receiving an initial antibiotic prescription for an acute viral respiratory infection – the type of infection that does not respond to antibiotics – increases the likelihood that a patient or their spouse will seek care for future infections of this type and receive subsequent antibiotic prescriptions , according to findings from a study by Harvard Medical School and Harvard TH Chan School of Public Health.
The analysis, published online August 10 in Clinical infectious diseases, is believed to be the first to measure how variation in antibiotic prescribing patterns by physicians affects patients’ care-seeking behavior and long-term antibiotic use.
The findings are alarming because they suggest that once such prescriptions are improperly administered for a viral infection, they could become a gateway to more antibiotic use, the researchers said. Overuse of antibiotics is common. Previous studies have shown that nearly a quarter of antibiotics prescribed in an outpatient setting are administered inappropriately for a diagnosis that does not warrant antibiotic treatment.
“The choices doctors make about prescribing antibiotics can have long-term effects on when individual patients choose to get treatment,” said study lead author Zhuo Shi, an HMS student in the Harvard-MIT Program in Health Sciences and Technology. “A doctor who prescribes an antibiotic inappropriately must understand that it’s not just a small prescription of a harmless antibiotic, but a potential gateway to a much bigger problem.”
The researchers used meeting data from a national insurer to analyze more than 200,000 initial visits for acute respiratory infections (ARI) at 736 emergency care centers in the United States. At those centers, the researchers found that antibiotic prescription rates for ARI varied widely among doctors. In the top quartile of prescribers, 80% of doctors prescribed antibiotics for viral respiratory infections, and in the lowest 42% did. To understand the impact of increased antibiotic prescribing, the researchers exploited the fact that patients do not choose their doctor for urgent care. They are essentially randomly assigned to a doctor.
In the year following an initial ARI visit, patients seen by doctors in the highest prescription group received 14.6 percent more antibiotics for ARI – three more antibiotic prescriptions filled per 100 patients – than patients seen with the lowest prescription of doctors antibiotics. The analysis showed that the increase in ARI antibiotic prescriptions for patients was largely driven by an increase in the number of ARI visits, an increase of 5.6 ARI visits per 100 patients, rather than a higher rate. prescription of antibiotics during those subsequent ARI visits, the analysis showed.
It wasn’t that they were more likely to receive antibiotics during repeat visits, the researchers found, simply that each return visit offered another opportunity to receive antibiotics.
Because? In the case of a viral disease, patients mistakenly attribute the improvement in symptoms to antibiotics. Of course, the next time they have similar symptoms they believe they need more antibiotics, the researchers said.
“You’ll hear many people say, ‘Every winter I need antibiotics for bronchitis,'” said study senior author Ateev Mehrotra, associate professor of health policy at Harvard Medical School’s Blavatnik Institute and a hospitalist at Beth Israel. Deaconess Medical Center. “Antibiotics don’t really help, but patients tend to perceive a benefit. The fancy term for this psychological phenomenon is ‘illusory correlation’.”
“They get antibiotics and they feel better, not because the antibiotics worked, but because the infection has run its course,” Mehrotra said. “The next time they get similar symptoms they go back to the doctor to get another prescription.”
And the lesson isn’t just learned by the patients themselves. Their spouses showed similar increases in visits and antibiotic use for ARI.
Inappropriate antibiotic use is a serious problem, the researchers said, noting that the practice increases spending unnecessarily, exposes patients to risk of side effects for no medical reason, and helps drive the increase in antibiotic-resistant strains of bacteria. .
Using meeting data from a national insurer, the researchers ranked doctors within each urgent care center based on their ARI antibiotic prescription rate. The fact that patients for urgent care are randomly assigned to a doctor ruled out the possibility of patients choosing a doctor they knew would likely give them antibiotics for their viral infection, allowing researchers to examine the impact of the behavior. of the doctor about the future behavior of the patient. The researchers looked at the association between the physician’s antibiotic prescription rate and the patients’ rate of ARI antibiotic administration, as well as the rate of antibiotic administration by their spouses in the following year. Several members of the research team applied this method for the first time to examine opioid prescription samples.
Although there is a lot of anecdotal evidence that some doctors claim to give antibiotics to patients requiring them to improve patient satisfaction, the researchers wanted to see if and how medical prescribing behavior might fuel the effect. They decided to answer the question: Could an initial prescription from a physician highly prescribe future antibiotic-seeking behavior among patients?
It does so, the analysis showed, and the study, the researchers said, underscores the continuing need to educate doctors and patients on judicious prescribing practices to reduce inappropriate prescribing, as well as antibiotic overuse and associated risks.
Support for this study was provided by the Office of the Director, National Institutes of Health (grant 1DP5OD017897).
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