title: Expectations for consultations and antibiotics for respiratory tract infection in primary care: the RTI clinical iceberg.
abstract: BACKGROUND
  Respiratory tract infection (RTI) is the commonest indication for community antibiotic prescriptions. Prescribing is rising and is influenced by patients' consulting behaviour and beliefs.
  
  
  OBJECTIVE
  To build up a profile of the 'RTI clinical iceberg' by exploring how the general public manage RTI, visit GPs and why.
  
  
  METHODS
  Two-phase qualitative and quantitative study in England.
  
  
  METHODS
  Qualitative interviews with 17 participants with acute RTI visiting pharmacies in England, and face-to-face questionnaire survey of 1767 adults ≥15 years in households in England during January 2011.
  
  
  RESULTS
  Qualitative interviews: interviewees with RTI visited GPs if they considered their symptoms were prolonged, or severe enough to cause pain, or interfered with daily activities or sleep. Questionnaire: 58% reported having had an RTI in the previous 6 months, and 19.7% (95% CI = 16.8 to 22.9%) of these contacted or visited their GP surgery for this, most commonly because 'the symptoms were severe'; or 'after several days the symptoms hadn't improved'; 10.3% of those experiencing an RTI (or 53.1% of those contacting their GP about it) expected an antibiotic prescription. Responders were more likely to believe antibiotics would be effective for a cough with green rather than clear phlegm. Perceptions of side effects of antibiotics did not influence expectations for antibiotics. Almost all who reported asking for an antibiotic were prescribed one, but 25% did not finish them.
  
  
  CONCLUSIONS
  One-fifth of those with an RTI contact their GP and most who ask for antibiotics are prescribed them. A better public understanding about the lack of benefit of antibiotics for most RTIs and addressing concerns about illness duration and severity, could reduce GP consultations and antibiotic prescriptions for RTI.
authors.affiliation: Public Health England, Gloucester. cliodna.mcnulty@phe.gov.uk
authors.forename: Cliodna A M
authors.initials: CA
authors.lastname: McNulty
authors.forename: Tom
authors.initials: T
authors.lastname: Nichols
authors.forename: David P
authors.initials: DP
authors.lastname: French
authors.forename: Puja
authors.initials: P
authors.lastname: Joshi
authors.forename: Chris C
authors.initials: CC
authors.lastname: Butler
mesh_terms: D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D004739:England / Q000453:epidemiology; D005260:Female; D058006:General Practice; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000592:standards / Q000639:trends; D036301:Qualitative Research; D012017:Referral and Consultation; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D016903:Drug Monitoring
chemical_list: D000900:Anti-Bacterial Agents