title: Combined assessment of clinical and patient factors on doctors' decisions to prescribe antibiotics.
abstract: Antibiotic overprescription is a worldwide problem. Decisions regarding antibiotic prescription for respiratory tract infections (RTIs) are influenced by medical and non-medical factors.
  
  
  
  In family medicine practices in Białystok, Poland, family medicine residents directly observed consultations with patients with RTI symptoms. The observing residents completed a questionnaire including patient data, clinical symptoms, diagnosis, any prescribed antibiotic, and assessment of ten patient pressure factors.
  
  
  
  Of 1546 consultations of patients with RTIs, 54.26 % resulted in antibiotic prescription. Antibiotic prescription was strongly associated with rales (OR 26.90, 95 % CI 9.00-80.40), tonsillar exudates (OR 13.03, 95 % CI 7.10-23.80), and wheezing (OR 14.72, 95 % CI 7.70-28.10). The likelihood of antibiotic prescription was increased by a >7-day disease duration (OR 3.94, 95 % CI 2.80-5.50), purulent nasal discharge (OR 3.87, 95 % CI 2.40-6.10), starting self-medication with antibiotics (OR 4.11, 95 % CI 2.30-7.30), and direct request for antibiotics (OR 1.87, 95 % CI 1.30-2.80). Direct request not to prescribe antibiotics decreased the likelihood of receiving antibiotics (OR 0.34, 95 % CI 0.27-0.55).
  
  
  
  While clinical signs and symptoms principally impact prescribing decisions, patient factors also contribute. The most influential patient pressure factors were starting self-medication with antibiotics, and directly requesting antibiotic prescription or no antibiotic prescription. Interventions aiming to improve clinical sign and symptom interpretation and to help doctors resist direct patient pressure could be beneficial for reducing unnecessary antibiotic prescribing.
authors.affiliation: Department of Family Medicine and Community Nursing, Medical University of Białystok, Mieszka I 4B, 15-054, Białystok, Poland. julia.strumilo@poczta.onet.pl.
authors.forename: Julia
authors.initials: J
authors.lastname: Strumiło
authors.affiliation: Department of Family Medicine and Community Nursing, Medical University of Białystok, Mieszka I 4B, 15-054, Białystok, Poland.
authors.forename: Sławomir
authors.initials: S
authors.lastname: Chlabicz
authors.affiliation: Department of Family Medicine and Community Nursing, Medical University of Białystok, Mieszka I 4B, 15-054, Białystok, Poland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Pytel-Krolczuk
authors.affiliation: Department of Family Medicine and Community Nursing, Medical University of Białystok, Mieszka I 4B, 15-054, Białystok, Poland.
authors.forename: Ludmiła
authors.initials: L
authors.lastname: Marcinowicz
authors.affiliation: Department of Family Medicine and Community Nursing, Medical University of Białystok, Mieszka I 4B, 15-054, Białystok, Poland.
authors.forename: Dorota
authors.initials: D
authors.lastname: Rogowska-Szadkowska
authors.affiliation: Department of Statistics and Medical Informatics, Medical University of Białystok, Białystok, Poland.
authors.forename: Anna Justyna
authors.initials: AJ
authors.lastname: Milewska
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making; D059026:Diagnostic Self Evaluation; D005122:Exudates and Transudates; D005194:Family Practice; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D014066:Palatine Tonsil; D057240:Patient Preference; D012135:Respiratory Sounds / Q000209:etiology; D012141:Respiratory Tract Infections / Q000150:complications / Q000188:drug therapy*; D012651:Self Medication; D012720:Severity of Illness Index; D063189:Symptom Assessment; D013997:Time Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antimicrobial agents; Family physicians; Physician–patient relations; Respiratory tract infections