Care-seeking behavior for upper respiratory infections

BACKGROUND: Many recent efforts to reduce unnecessary medical services have targeted care of upper respiratory infections (URIs). We tested whether patients who seek care very early in their illness differ from those who seek care later and whether they might require a different approach to care. METHODS: We surveyed by telephone 257 adult patients and 249 parents of child patients who called or visited one of 3 primary care clinics within 10 days (adults) or 14 days (parents) of the onset of uncomplicated URI symptoms. Those who contacted the clinic within the first 2 days of illness were compared with those who made contact later. RESULTS: Although 28% of adults and 41% of parents contacted their clinic within the first 2 days of symptom onset, we found very few differences in the characteristics of the caller or patient between those who called early and later. The illnesses of those who called early were not more severe, and they did not have different beliefs, histories, approaches to medical care, or needs. The only clinician-relevant difference was that adult patients calling in the first 2 days had a greater desire to rule out complications (84.7% vs 64.1% calling in 3-5 days and 70.6% calling after 5 days of illness, P < or = .05). CONCLUSIONS: Those who seek medical care very early for a URI do not appear to be different in clinically important ways. If we are going to reduce overuse of medical care and antibiotics for URIs, clinical trials of more effective and efficient strategies are needed to encourage home care and self-management.     

Debiasing effects of education about appropriate antibiotic use on consumers' preferences for physicians

A major goal of this research was to identify an antibiotic education intervention that would increase young adult consumers' preference for physicians who do not unnecessarily prescribe antibiotics for simple acute upper respiratory infections (URIs). Results clearly showed that consumers who read the CDC brochure entitled, "A New Threat to Your Health: Antibiotic Resistance" significantly preferred the physician who would not prescribe antibiotics for a URI on Day 3. They also inferred that this physician had significantly greater ability than the physician who would prescribe antibiotics. In contrast, consumers who did not read the CDC brochure significantly preferred the physician who would prescribe antibiotics for a URI on Day 3. They also inferred that this physician had significantly greater ability and greater concern for patients than the physician who would not prescribe antibiotics. Thus, consumers with low knowledge exhibited a treatment bias and preferred physicians who provided more treatment, and consumer education successfully reversed the treatment bias.     

Use and perceptions of antibiotics for upper respiratory infections among college students

BACKGROUND: Upper respiratory infections (URIs) are mainly viral in nature, rendering antibiotics ineffective. Little is known about what college students believe concerning the effectiveness of antibiotics as a treatment for URIs. METHODS: Students (n=425) on 3 college campuses were surveyed using a survey describing 3 variations in presentation of an uncomplicated URI. Participants were questioned about their likelihood of using a variety of treatments for the URI and about their likelihood of seeking a physician's care. RESULTS: The percentage of students endorsing antibiotic use differed significantly by symptom complex. Likelihood of seeking medical care also differed significantly across symptom groups, with greater endorsement in the discolored nasal discharge and low-grade fever scenarios. Stepwise multiple regression analysis revealed that belief in antibiotic effectiveness for cold symptoms decreased with tic and Therapeutic increasing years of higher education. Likelihood of antibiotic use across different scenarios increased with age. Likelihood of seeking care across different scenarios was related to type of health insurance and belief in antibiotic effectiveness. CONCLUSIONS: Undergraduate college students show poor recognition of typical presentations of the common cold and have misconceptions about effective treatment. Although increasing years of college correlated with decreasing belief in antibiotics' effectiveness for a cold, more health education at the college level is recommended.     

5岁以下上呼吸道感染儿童合理用药研究

目的 分析5岁以下上呼吸道感染儿童合理用药情况.方法 采用世界卫生组织推荐的方法随机抽取1 200份上呼吸道感染儿童门诊处方,对其平均用药个数、注射剂使用比例、抗生素使用比例、抗生素联用比例、激素使用比例进行分析.结果 单张处方平均用药个数为2.72,注射剂使用比例为48.00%,抗生素使用比例为56.83%,抗生素联用比例为4.50%,激素使用比例为14.00%.不同职称医务人员处方指标存在差异性.结论 5岁以下上呼吸道感染儿童不合理用药情况较为严重,有必要采取更有效的干预措施促进医生的处方行为.     

Reducing antibiotics for colds and flu: a student-taught program

A student peer-taught program, to decrease antibiotic use for colds and flu, was developed and implemented in one school district (21 schools) in Chisinau, Moldova, in 2003-04. A second district (20 schools) served as the control (C). Students (12-13 years) and adults most responsible for the family's health care completed surveys in March pre-post intervention. The surveys determined the reported incidence of colds and flu during the past winter, treatment, beliefs about cause and usefulness of antibiotics. The intervention included peer-education sessions, parents' meetings, booklet, vignette video, newsletters, poster and poster contest. The intervention also provided basic information on appropriate use of medicines. Pre-post intervention survey results indicated that the intervention was successful. Adjusted for Cs, students who reported they did not treat colds or flu with antibiotics increased 33.7%; the comparable increase for adults was 38.0%. Adjusted for Cs, intervention students who did not know if they had used an antibiotic decreased 15.1% and for intervention adults the comparable decrease was 5.0%. All relative responses related to beliefs about the cause of colds and flu and the usefulness of antibiotics to treat them changed in a positive direction. In all groups, beliefs and behaviors relative to antibiotic use were related.     

Adolescents' health beliefs are critical in their intentions to seek physician care

BACKGROUND: The examination of predictors of adolescents' intentions to use health care for different types of health issues has received little attention. This study examined adolescents' health beliefs and how they relate to intentions to seek physician care across different types of health problems. METHODS: Two hundred ten high school students (54% females; 76.6% participation rate) completed a self-administered survey of four separate age- and gender-specific health case scenarios: an adolescent who has symptoms of pneumonia; smokes five cigarettes daily; plans to initiate sex; and has symptoms of depression. For each health scenario, participants rated the seriousness of the health problem, physician effectiveness, and intentions to seek physician care. RESULTS: Most adolescents believed all health problems were serious except for planning to initiate sex (P < 0.001). Adolescents believed that physicians were most effective in diagnosis and treatment for pneumonia, followed by cigarette use, depression, and sex, respectively (P's < 0.001). Adolescents' intentions to seek physician care were greatest for physical as compared to risk behavior or mental health problems (P < 0.001). Multiple regression analyses revealed that adolescents had greater intentions to seek physician care for cigarette, sex, and depression when they believed physicians were effective and they perceived these as health problems after controlling for age and gender (all P's < 0.001). Health beliefs explained 12% to 49% of the variance in intentions to seek care (all P's < 0.001). CONCLUSIONS: Adolescents' health beliefs are important when understanding intentions to seek physician care. Health care use may be improved by increasing adolescents' beliefs that physicians are effective in areas other than physical health, including risk behaviors and mental health.     

Clinical features and treatment of acute bronchitis

Although several surveys rank acute bronchitis as one of the ten most frequent diagnoses made by primary care physicians, its clinical features are poorly defined and treatment with antibiotics is controversial. This study was designed to determine the clinical characteristics that providers use to diagnose acute bronchitis and to examine the use of antibiotics in treating this illness. Charts of patients with the diagnosis of acute bronchitis or upper respiratory tract infection (URI) were randomly selected and progress notes from these visits were reviewed. Signs, symptoms, laboratory tests, and antibiotics prescribed were recorded. Patients with a diagnosis of acute bronchitis had more productive cough, purulent sputum, and abnormal lung examinations than patients with a diagnosis of URI (P less than .05 for each characteristic). Laboratory tests, including chest roentgenograms, were not frequently used in making the diagnosis of acute bronchitis. Antibotics were prescribed for 27 of 29 patients (92 percent) with a diagnosis of acute bronchitis but for only 4 of 19 patients (21 percent) with a diagnosis of URI. Erythromycin was prescribed for 60 percent of patients with acute bronchitis. From this study it can be concluded that providers use the term acute bronchitis to designate a specific clinical syndrome that they treat with antibiotics. Further clinical trials are needed to evaluate the efficacy of such antibiotic therapy.     

Knowledge and Misconceptions Regarding Upper Respiratory Infections and Influenza Among Urban Hispanic Households: Need for Targeted Messaging

Background To characterize knowledge and misconceptions regarding viral upper respiratory infections (URI) among urban Hispanics and identify correlates of greater knowledge. Methods In-home interviews conducted by trained research coordinators in 453 primarily Hispanic households (2,386 members) in northern Manhattan. Results The majority of respondents attributed URI to weather-related conditions. While most agreed that colds and flu were caused by viruses, 88.1% also agreed that they were caused by bacteria, and a small proportion reported that URI may be caused by evil eye (‘mal de ojo’, 7.1%) or sudden fright (‘susto’, 3.3%). Only 29.8% agreed that colds and flu would improve without medication; 89.9% stated that antibiotics are needed to treat viral throat infections. Most were well versed about influenza vaccination and reported that a recommendation from a healthcare provider would definitely influence them to get vaccinated. Discussion Misconceptions about the role of antibiotics in the treatment of viral infections pose considerable risk in this population. Explicit, targeted recommendations from healthcare providers regarding vaccination and judicious antibiotic use as well as media campaigns targeted to Hispanics should be effective strategies for reducing misconceptions and improving health behaviors.