title: From Visiting a Physician to Expecting Antibiotics: Korean Perspectives and Practices toward Respiratory Tract Infections.
abstract: Antibiotic resistance is steadily rising worldwide. Respiratory tract infections (RTIs) are common indications, mostly imprudent, for antibiotic prescriptions in outpatient setting. In Korea, antibiotic prescription rate for RTIs is still high. As physician visit and antibiotic prescribing are influenced by patient's perceptions and beliefs, we aimed to explore the general public's perspectives and practices toward RTIs and to develop the 'RTI clinical iceberg.' A cross-sectional survey was conducted in Wonju Severance Christian Hospital (WSCH) among 550 adults attending outpatient departments during January 2016. Differences in distributions between groups were examined using two-tailed Pearson χ² test. Using the Andersen's behavioral model as a conceptual framework, we constructed logistic regression models to assess factors associated with physician visit. Of 547 participants with complete questionnaires, 62.9% reported having experienced an RTI in the previous six months; 59.3% visited a physician for the illness, most commonly because the symptoms were severe or prolonged, and approximately 16% of them expected an antibiotic prescription from the visit. Perceptions of symptoms severity, the need factor, most strongly influenced physician visit. Predisposing and enabling factors such as inappropriate expectations for antibiotic for a sore throat or having national health insurance also influenced physician visit. Almost all participants who reported asking for an antibiotic were prescribed one, with a 37.1% non-adherence rate. Conclusively, public education on self-care for RTI symptoms that addresses their main concerns may reduce physician visits. Improving physician-patient relationship and informing patients about the lack of antibiotic benefit for most RTIs may also reduce antibiotic prescriptions.
authors.affiliation: Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.|Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, Korea.
authors.forename: Leila
authors.identifier: http://orcid.org/0000-0003-3607-9032
authors.initials: L
authors.lastname: Freidoony
authors.affiliation: Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.|Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, Korea.|Institute of Occupation and Environmental Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea. kimcb@yonsei.ac.kr.
authors.forename: Chun Bae
authors.identifier: http://orcid.org/0000-0002-1979-6833
authors.initials: CB
authors.lastname: Kim
authors.affiliation: Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Hamid
authors.identifier: http://orcid.org/0000-0002-2239-7139
authors.initials: H
authors.lastname: Haghani
authors.affiliation: Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.|Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, Korea.
authors.forename: Myung Bae
authors.identifier: http://orcid.org/0000-0002-1892-6632
authors.initials: MB
authors.lastname: Park
authors.affiliation: Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.|Institute of Occupation and Environmental Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Sei Jin
authors.identifier: http://orcid.org/0000-0001-9347-3592
authors.initials: SJ
authors.lastname: Chang
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Sang Ha
authors.identifier: http://orcid.org/0000-0002-1763-5366
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.|Institute of Occupation and Environmental Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Sang Baek
authors.identifier: http://orcid.org/0000-0001-5609-6521
authors.initials: SB
authors.lastname: Koh
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D044466:Asian People; D003430:Cross-Sectional Studies; D003710:Demography; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D056910:Republic of Korea; D012141:Respiratory Tract Infections / Q000517:prevention & control / Q000523:psychology*; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents
keywords: Adherence; Antibiotics; Attitudes; Expectations; Physician Visit; Practices; Respiratory Tract Infections; South Korea