Reducing reconsultations for acute lower respiratory tract illness with an information leaflet: a randomized controlled study of patients in primary care.
BACKGROUND
General practitioners (GPs) prescribe antibiotics to three-quarters of patients who consult with a lower respiratory tract illness (LRTi). In spite of this management, around a quarter of patients reconsult for the same symptoms within a month.


OBJECTIVE
To investigate the impact of providing a simple leaflet regarding the natural history of lower respiratory tract symptoms on reconsultation rates for previously well adults presenting to their GP with an LRTi.


METHODS
Seventy-six GPs studied 1014 previously well adults presenting with an illness defined as an LRTi. Management was left to the GP's discretion. Half of the patients were randomly allocated to receive an information leaflet at the end of the consultation, blinded from the GP. The endpoint was reconsultation for the same symptoms within one month.


RESULTS
Follow-up data was available for 1006 adults, of whom 182 (18%) reconsulted. Fewer patients who received the leaflet (75/505; 14.9%) returned to the surgery compared with those who did not (107/501; 21.4%; P = 0.007). The same benefit was found for the 723 (72%) adults treated initially with antibiotics; 16% (60/369) in the leaflet group returned compared with 23% (81/354) in the no leaflet group (P = 0.02).


CONCLUSIONS
Informing previously well patients about the natural history of LRTi symptoms is an effective strategy for reducing reconsultations, benefiting the patient and the GP; it is likely to reduce antibiotic prescriptions and future patient consultation habits.
Macfarlane
J T
JT
Respiratory Infection Unit, Nottingham City Hospital.
Holmes
W F
WF
Macfarlane
R M
RM
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000628:therapy*
D000900:Anti-Bacterial Agents