title: Results from a Patient-Based Health Education Intervention in Reducing Antibiotic Use for Acute Upper Respiratory Tract Infections in the Private Sector Primary Care Setting in Singapore.
abstract: We investigated the efficacy of patient-targeted education in reducing antibiotic prescriptions for upper respiratory tract infections (URTIs) among adults in the private primary care setting in Singapore. Our randomized controlled trial enrolled patients aged 21 years and above presenting at general practitioner (GP) clinics with URTI symptoms for 7 days or less. Intervention arm patients were verbally educated via pamphlets about the etiology of URTIs, the role of antibiotics in treating URTIs, and the consequences of inappropriate antibiotic use. Control arm patients were educated on influenza vaccinations. Both arms were compared regarding the proportions prescribed antibiotics and the patients' postconsultation views. A total of 914 patients consulting 35 doctors from 24 clinics completed the study (457 in each arm). The demographics of patients in both arms were similar, and 19.1% were prescribed an antibiotic, but this varied from 0% to 70% for individual GPs. The intervention did not significantly reduce antibiotic prescriptions (odds ratio [OR], 1.20; 95% confidence interval [CI], 0.83-1.73) except in patients of Indian ethnicity (OR, 0.28; 95% CI, 0.09-0.93). Positive associations between the intervention and the view that antibiotics were not needed most of the time for URTIs (P= 0.047) and on being worried about the side effects of antibiotics (P= 0.018) were restricted to the Indian subgroup. GPs in limited liability partnerships or clinic chains prescribed less (OR, 0.36; 95% CI, 0.14 to 0.92), while certain inappropriate patient responses were associated with the receipt of antibiotics. Follow-up studies to investigate differences in responses to educational programs between ethnicities and to explore GP-targeted interventions are recommended.
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Magdalene Hui Min
authors.initials: MHM
authors.lastname: Lee
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Darius Shaw Teng
authors.initials: DST
authors.lastname: Pan
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Joyce Huixin
authors.initials: JH
authors.lastname: Huang
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore mark.chen.ic@gmail.com.|Institute of Infectious Diseases and Epidemiology, Communicable Disease Centre, Tan Tock Seng Hospital, Singapore.
authors.forename: Mark I-Cheng
authors.initials: MI
authors.lastname: Chen
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: Joash Wen Chen
authors.initials: JWC
authors.lastname: Chong
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: Ee Hui
authors.initials: EH
authors.lastname: Goh
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: Lili
authors.initials: L
authors.lastname: Jiang
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.|Saw Swee Hock School of Public Health, National University of Singapore, Singapore.|Institute of Infectious Diseases and Epidemiology, Communicable Disease Centre, Tan Tock Seng Hospital, Singapore.|Lee Kong Chian School of Medicine, Nan Yang Technological University, Singapore.
authors.forename: Yee Sin
authors.initials: YS
authors.lastname: Leo
authors.affiliation: Institute of Infectious Diseases and Epidemiology, Communicable Disease Centre, Tan Tock Seng Hospital, Singapore.
authors.forename: Tau Hong
authors.initials: TH
authors.lastname: Lee
authors.affiliation: Institute of Infectious Diseases and Epidemiology, Communicable Disease Centre, Tan Tock Seng Hospital, Singapore.
authors.forename: Chia Siong
authors.initials: CS
authors.lastname: Wong
authors.affiliation: Division of Family Medicine, Department of Medicine, University Medicine Cluster, National University Hospital System, Singapore.
authors.forename: Victor Weng Keong
authors.initials: VWK
authors.lastname: Loh
authors.affiliation: Division of Family Medicine, Department of Medicine, University Medicine Cluster, National University Hospital System, Singapore.
authors.forename: Fong Seng
authors.initials: FS
authors.lastname: Lim
authors.affiliation: Frontier Healthcare Group, Singapore.
authors.forename: Adrian Zhongxian
authors.initials: AZ
authors.lastname: Poh
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.|Division of Family Medicine, Department of Medicine, University Medicine Cluster, National University Hospital System, Singapore.|Frontier Healthcare Group, Singapore.
authors.forename: Tat Yean
authors.initials: TY
authors.lastname: Tham
authors.affiliation: Division of Family Medicine, Department of Medicine, University Medicine Cluster, National University Hospital System, Singapore.|Division of Primary Care, Raffles Medical Group, Singapore.|Duke NUS Graduate Medical School, National University of Singapore, Singapore.
authors.forename: Wei Mon
authors.initials: WM
authors.lastname: Wong
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Yue
authors.initials: Y
authors.lastname: Yu
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000073602:Antimicrobial Stewardship / Q000379:methods*; D006266:Health Education / Q000379:methods*; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D007252:Influenza Vaccines / Q000627:therapeutic use; D010174:Pamphlets; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D012846:Singapore
chemical_list: D000900:Anti-Bacterial Agents; D007252:Influenza Vaccines
keywords: antibiotics; antimicrobial stewardship; intervention; upper respiratory tract infection