Antibiotic prescribing for acute cough: the effect of perceived patient demand.
BACKGROUND
GPs decide whether or not to prescribe antibiotics for acute cough. Apart from clinical signs and symptoms, non-medical reasons influence this decision as well.


OBJECTIVE
To obtain a valid estimate of the effect of perceived patient demand.


METHODS
Secondary analysis of cluster randomised controlled trial data.


METHODS
Eighty-five Flemish GPs.


METHODS
GPs completed a preprinted form with medical as well as non-medical information and their prescription for 20 consecutive adult patients consulting with acute cough in the periods February to April 2000 and 2001. The effect of perceived patient demand on antibiotic prescribing was estimated by performing alternating logistic regression analysis. A hierarchical backwards elimination procedure, described by Kleinbaum, was used.


RESULTS
Seventy-two GPs participated, including 1448 patients eligible for analysis; 500 (34.5%) were prescribed an antibiotic and, according to the GP, 218 (15.1%) asked for an antibiotic. In cases of perceived patient demand antibiotics were prescribed significantly more often (odds ratio [OR] = 4.64, 95% confidence interval [CI] = 2.96 to 7.26). In the final model (n = 819; OR = 4.60, 2.59 to 8.17); Hosmer-Lemeshow goodness-of-fit P = 0.72), the effect of perceived patient demand for an antibiotic depended on the outcome of the lung auscultation. When patient demand was perceived, antibiotics were prescribed significantly more often only in the case of a normal lung auscultation or in the case of only one abnormal auscultatory finding (adjusted OR = 20.83, 95% CI = 8.86 to 48.99; adjusted OR = 4.79; 95% CI = 2.16 to 10.60, respectively).


CONCLUSIONS
Perceived patient demand has a significant, independent and clinically relevant effect on antibiotic prescribing for acute cough with negative findings on the lung auscultation. Practice guidelines and interventions to optimise antibiotic prescribing have to take this effect into account.
Fund for Scientific Research, Flanders, Belgium. samuel.coenen@ua.ac.be
Samuel
S
Coenen
Barbara
B
Michiels
Didier
D
Renard
Joke
J
Denekens
Paul
P
Van Royen
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001530:Belgium; D003371:Cough / Q000188:drug therapy* / Q000209:etiology; D003657:Decision Making; D005194:Family Practice; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians'; D016032:Randomized Controlled Trials as Topic; D012141:Respiratory Tract Infections / Q000150:complications / Q000188:drug therapy*; D011795:Surveys and Questionnaires
D000900:Anti-Bacterial Agents