title: Are patient views about antibiotics related to clinician perceptions, management and outcome? A multi-country study in outpatients with acute cough.
abstract: BACKGROUND
  Outpatients with acute cough who expect, hope for or ask for antibiotics may be more unwell, benefit more from antibiotic treatment, and be more satisfied with care when they are prescribed antibiotics. Clinicians may not accurately identify those patients.
  
  
  OBJECTIVE
  To explore whether patient views (expecting, hoping for or asking for antibiotics) are associated with illness presentation and resolution, whether patient views are accurately perceived by clinicians, and the association of all these factors with antibiotic prescribing and patient satisfaction with care.
  
  
  METHODS
  Prospective observational study of 3402 adult patients with acute cough presenting in 14 primary care networks. Correlations and associations tested with multilevel logistic regression and McNemar 's tests, and Cohen's Kappa, positive agreement (PA) and negative agreement (NA) calculated as appropriate.
  
  
  RESULTS
  1,213 (45.1%) patients expected, 1,093 (40.6%) hoped for, and 275 (10.2%) asked for antibiotics. Clinicians perceived 840 (31.3%) as wanting to be prescribed antibiotics (McNemar's test, p<0.05). Their perception agreed modestly with the three patient views (Kappa's = 0.29, 0.32 and 0.21, PA's = 0.56, 0.56 and 0.33, NA's = 0.72, 0.75 and 0.82, respectively). 1,464 (54.4%) patients were prescribed antibiotics. Illness presentation and resolution were similar for patients regardless their views. These associations were not modified by antibiotic treatment. Patient expectation and hope (OR:2.08, 95% CI:[1.48,2.93] and 2.48 [1.73,3.55], respectively), and clinician perception (12.18 [8.31,17.84]) were associated with antibiotic prescribing. 2,354 (92.6%) patients were satisfied. Only those hoping for antibiotics were less satisfied when antibiotics were not prescribed (0.39 [0.17,0.90]).
  
  
  CONCLUSIONS
  Patient views about antibiotic treatment were not useful for identifying those who will benefit from antibiotics. Clinician perceptions did not match with patient views, but particularly influenced antibiotic prescribing. Patients were generally satisfied with care, but those hoping for but not prescribed antibiotics were less satisfied. Clinicians need to more effectively elicit and address patient views about antibiotics.
authors.affiliation: Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium ; Centre for General Practice, Department of Primary and Interdisciplinary Care Antwerp, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
authors.forename: Samuel
authors.initials: S
authors.lastname: Coenen
authors.forename: Nick
authors.initials: N
authors.lastname: Francis
authors.forename: Mark
authors.initials: M
authors.lastname: Kelly
authors.forename: Kerenza
authors.initials: K
authors.lastname: Hood
authors.forename: Jacqui
authors.initials: J
authors.lastname: Nuttall
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.forename: Theo J M
authors.initials: TJ
authors.lastname: Verheij
authors.forename: Hasse
authors.initials: H
authors.lastname: Melbye
authors.forename: Herman
authors.initials: H
authors.lastname: Goossens
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Butler
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003371:Cough / Q000188:drug therapy*; D005060:Europe; D006801:Humans; D016015:Logistic Models; D010342:Patient Acceptance of Health Care; D063046:Patient Medication Knowledge / Q000706:statistics & numerical data*; D010358:Patient Participation; D017060:Patient Satisfaction; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents