title: Help-seeking and antibiotic prescribing for acute cough in a Chinese primary care population: a prospective multicentre observational study.
abstract: Acute cough is a common reason to prescribe antibiotics in primary care. This study aimed to explore help-seeking and antibiotic prescribing for acute cough in Chinese primary care population. This is a prospective multicentre observational study that included adults presenting with acute cough. Clinicians recorded patients' presenting symptoms, examination findings and medication prescription. Patients completed symptom diaries for up to 28 days by charting their symptom severity and recovery. Adjusted binary logistic regression models identified factors independently associated with antibiotic prescription. Primary care clinicians (n=19) recruited 455 patients. A total of 321 patients (70.5%) returned their completed symptom diaries. Concern about illness severity (41.6%) and obtaining a prescription for symptomatic medications (45.9%), rather than obtaining a prescription for antibiotics, were the main reasons for consulting. Antibiotics were prescribed for 6.8% (n=31) of patients, of which amoxicillin was the most common antimicrobial prescribed (61.3%), as it was associated with clinicians' perception of benefit from antibiotic treatment (odds ratio (OR): 25.9, 95% confidence interval (CI): 6.7-101.1), patients' expectation for antibiotics (OR: 5.1, 95% CI: 1.7-11.6), anticipation (OR: 5.1, 95% CI: 1.6-15.0) and request for antibiotics (OR 15.7, 95% CI: 5.0-49.4), as well as the severity of respiratory symptoms (cough, sputum, short of breath and wheeze OR: 2.7-3.7, all P<0.05). There was a significant difference in antibiotic prescription rates between private primary care clinicians and public primary care clinicians (17.4 vs 1.6%, P=0.00). Symptomatic medication was prescribed in 98.0% of patients. Mean recovery was 9 days for cough and 10 days for all symptoms, which was not significantly associated with antibiotic treatment. Although overall antibiotic-prescribing rates were low, there was a higher rate of antibiotic prescribing among private primary care clinicians, which warrants further exploration and scope for education and intervention.
authors.affiliation: Division of Family Medicine and Primary Health Care, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Carmen Ka Man
authors.initials: CK
authors.lastname: Wong
authors.affiliation: Division of Family Medicine and Primary Health Care, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Zhaomin
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Nuffield Department of Primary Care Health Sciences Oxford University, New Radcliffe House, Radcliffe Observatory Quarter, Oxford, UK.|Cardiff University, Institute of Primary Care and Public Health, Cardiff, Wales.|Department of Family Medicine and Primary Care, University of Hong Kong, Hong Kong, China.
authors.forename: Chris C
authors.initials: CC
authors.lastname: Butler
authors.affiliation: Division of Family Medicine and Primary Health Care, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Samuel Yeung Shan
authors.initials: SY
authors.lastname: Wong
authors.affiliation: Division of Family Medicine and Primary Health Care, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Alice
authors.initials: A
authors.lastname: Fung
authors.affiliation: Division of Family Medicine and Primary Health Care, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Dicken
authors.initials: D
authors.lastname: Chan
authors.affiliation: Division of Family Medicine and Primary Health Care, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Benjamin Hon Kei
authors.initials: BH
authors.lastname: Yip
authors.affiliation: Department of Family Medicine and Primary Care, University of Hong Kong, Hong Kong, China.
authors.forename: Kenny
authors.initials: K
authors.lastname: Kung
mesh_terms: D000208:Acute Disease; D000328:Adult; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002681:China; D003371:Cough / Q000188:drug therapy*; D018450:Disease Progression; D005260:Female; D000066505:Help-Seeking Behavior; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017060:Patient Satisfaction; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D011446:Prospective Studies; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents; D000658:Amoxicillin