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.     

Performance failure of an evidence-based upper respiratory infection clinical guideline.

BACKGROUND: We evaluated an upper respiratory infection (URI) clinical guideline to determine if it would favorably affect the quality and cost of care in a health maintenance organization. METHODS: Patients with URI symptoms contacting 4 primary care practices before and after guideline implementation were compared to ascertain what proportion of all patients with respiratory symptoms were eligible for treatment in accordance with the URI guideline; what proportion of eligible patients were managed without an office visit; and what proportion of eligible patients were treated with antibiotics, before and after guideline implementation. RESULTS: A total of 3163 patients with respiratory symptoms were identified. Of these, 59% (n = 1880) had disqualifying symptoms or comorbid conditions for URI guideline care, and 28% (n = 1290) received disqualifying diagnoses on the day of first contact, leaving 13% (n = 408) who received a diagnosis of URI and were eligible for care in accordance with the guideline. Among this group of patients, the proportion who received guideline-recommended initial telephone care was 45% preguideline and 47% postguideline (chi2 = 0.40; P = .82). Likelihood of a subsequent office visit increased from pre- to postguideline (chi2 = 17.1; P <.01), although the majority of patients had no further diagnoses other than URI. Antibiotic use for the initial URI diagnosis declined from 24% preguideline to 16% postguideline (chi2 = 3.97; P = .046), but antibiotic use during 21-day follow-up did not change (F = 0.46, P = .66). The mean cost of initial care was $37.80 preguideline and $36.20 postguideline (P >.05). CONCLUSIONS: Only 13% of primary care patients with respiratory symptoms were eligible for URI guideline care. Among eligible patients, use of the guideline failed to decrease clinic visits, decrease antibiotic use during a 21-day period, or reduce cost of care to the health plan.     

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.     

大学生健康素养核心信息精确概率劝导模型分析结果评价

目的 以精确概率劝导模型对大学生健康素养核心信息进行健康教育实施前评价,为提高大学生健康教育效力提供依据.方法 采用分阶段目的抽样和方便抽样相结合的方法,在北京、昆明、广州、武汉、南京、哈尔滨和西安7个城市各选取4所不同类型非医学高校的1357名大学生进行调查.使用自编信息评价表,对大学生健康素养核心信息进行评价.结果 大学生不同信息得分存在差异.55条核心信息评价得分最高72.24分,最低62.79分.大学生对健康素养核心信息评价的影响因素为性别、个体对健康知识和对健康相关技能的认知.结论 在大学生健康教育中,应考虑大学生性别的影响,并根据大学生对信息的认同度来设置健康教育信息内容.     

Public knowledge,attitudes and behaviour regarding antibiotics

Objective: To assess public knowledge, attitudes and behaviour regarding antibiotics to provide information for a local health education policy.

Design: Postal survey to 605 patients registered with two general medical practices in Grampian, NorthEast Scotland (351 respondents, 59.3%) in February/ March 2000. Questionnaire topics covered attitudes, knowledge and behaviour towards antibiotic use.

Results: 326 (93%) bad experience of antibiotic use and 319 (81%) were happy to take antibiotics when necessary. 158 (45%) were concerned about antibiotic resistance. Few would expect antibiotics to treat a slight cold or heavy cold, but around half would expect antibiotics for very sore throats and influenza. 262 (75%) indicated they would ask a pharmacist for advice about the treatment of RTI. Most respondents experienced at least one episode of RTI during the review period. 280 (80%) provided details of their most recent episode; most self-treated, 57 consulted a doctor of whom 43 (75%) were prescribed antibiotics.

Conclusions: Antibiotic resistance is a matter of concern for the public. Mixed opinions about the use of antibiotics for common respiratory tract infection were heard. Encouragingly the majority of people suffering an RTI during the review period treated themselves with paracetamol-based products for symptom relief. Those who consulted a doctor were in the minority but were likely to be prescribed antibiotics. Future local health education initiatives should target antibiotic use for sore throats as well as colds and flu.     

Factors influencing antibiotic prescribing in China: an exploratory analysis

OBJECTIVES: China has very high rates of antibiotic resistance and a health care system that provides strong incentives for over-prescribing. This paper describes the findings of a qualitative study in a province of southern China that seeks to assess knowledge, attitudes, and practices in relation to the use of antibiotics. METHODS: Semi-structured interviews with patients and health workers at provincial, county, township, and village level. Interviews used four probes (common cold, cough, mild diarrhoea and tiredness) where antibiotics were not indicated, supplemented by questions on knowledge, attitudes, and practices. These data were supplemented by two focus groups, with medical students and pharmacists, and discussions with participants at a national conference on antibiotic use. RESULTS: Coughs and diarrhoea are almost universally treated with antibiotics, while the cold is normally treated with antivirals instead or as well. Many physicians are aware that the cold is usually self-limiting but believe that they can speed recovery and that they are responding to patient expectations. Most physicians and many patients are aware of the phenomenon of antibiotic resistance, although it is often seen as a property acquired by the patient and not the micro-organism. Physicians face financial incentives to prescribe, with profit splitting with pharmaceutical suppliers. Sales profits form a major part of a hospital's income. National guidance on use of antibiotics is fragmentary and incomplete. CONCLUSION: The misuse of antibiotics poses considerable risks. Effective action will require a multi-faceted strategy including education, based on an understanding of existing beliefs, the replacement of perverse incentives with those promoting best practice, and investment in improved surveillance. Much of this will require action at national level.     

在幼儿教育专业学生中开展口腔保健健康教育的效果评价

目的:了解健康教育对幼儿教育专业学生口腔保健相关知识、态度的影响。方法:以371名幼儿教育专业学生为研究对象,于健康教育前后,对学生进行口腔保健相关知识和态度方面的不记名问卷调查。结果:教育后学生口腔保健的基本知识平均得分由教育前的12.1分提高到17.8分(满分19分),两者相比差异有显著性。教育后对口腔保健及其相关问题的正向态度率均明显高于教育前。电化教育、文字教育和讲座是学生最希望获得口腔保健知识的方式。结论:在幼儿教育专业学生中开展有关口腔保健的健康教育,不仅必要而且可行和有效,对增加学生口腔保健的基本知识、树立与口腔保健有关的正确态度都有积极的影响,为他们今后在托幼机构的工作中,对学龄前儿童开展口腔健康教育奠定了一定的基础。     

Improving Care of Upper Respiratory Infections Among Latino Early Head Start Parents

Misconceptions about upper respiratory infections (URI) and their treatment are widely held, especially among Latino parents, and are associated with increased health care visits. The Centers for Disease Control and Prevention recommends community based interventions to educate families about URI. We designed a community-based, culturally competent health literacy intervention regarding URI, which was pilot tested with Latino Early Head Start (EHS) parents. In depth interviews were conducted to understand parents’ perceptions. A paired-sample Wilcoxon signed rank test was used to assess change in pre-post knowledge/attitudes scores. Changes in care practices are described. Parents were very positive about this education, were open to non-antibiotic URI care, and reported that materials were helpful. Following the intervention, the mean composite knowledge/attitude score increased from 4.1 (total: 10) to 6.6 (P < .05). Families also reported improved care practices. EHS sites are promising locations for health literacy interventions regarding URI.     

Multiprofessional learning: the attitudes of medical, nursing and pharmacy students to shared learning

OBJECTIVES: The belief that the effectiveness of patient care will improve through collaboration and teamwork within and between health care teams is providing a focus internationally for 'shared learning' in health professional education. While it may be hard to overcome structural and organizational obstacles to implementing interprofessional learning, negative student attitudes may be most difficult to change. This study has sought to quantify the attitudes of first-year medical, nursing and pharmacy students' towards interprofessional learning, at course commencement. DESIGN: The Readiness for Interprofessional Learning Scale (RIPLS) (University of Liverpool, Department of Health Care Education), was administered to first-year medical, nursing and pharmacy students at the University of Auckland. Differences between the three groups were analysed. SETTING: The Faculty of Medical and Health Sciences, University of Auckland. RESULTS: The majority of students reported positive attitudes towards shared learning. The benefits of shared learning, including the acquisition of teamworking skills, were seen to be beneficial to patient care and likely to enhance professional working relationships. However professional groups differed: nursing and pharmacy students indicated more strongly that an outcome of learning together would be more effective teamworking. Medical students were the least sure of their professional role, and considered that they required the acquisition of more knowledge and skills than nursing or pharmacy students. CONCLUSION: Developing effective teamworking skills is an appropriate focus for first-year health professional students. The timing of learning about the roles of different professionals is yet to be resolved.     

合肥某高校学生安全用药知识的现状调查分析

为了获得大学生的安全用药知识掌握情况,为学校开展安全用药健康教育课程提供参考。选取本校168名选修大学生健康教育课程的学生作为调查对象,并对回收的166份有效调查问卷进行统计分析。结果显示:166名大学生中只有17名(10.24%)大学生认为抗生素应在医生指导下使用,41名(24.7%)大学生使用抗生素时知道尽量使用普通的、窄谱的抗生素。45名(27.11%)大学生知道“OTC”是不需要医生开处方的药,70名(29.52%)大学生知道OTC是可自行按照说明书使用的药物,120名(72.29%)大学生是从学校的课程中获得安全用药知识的。可以看出,大学生的安全用药知识比较匮乏,特别是对抗生素的合理使用认识不足,对大学生进行安全用药知识的健康教育迫在眉睫。     

Use of the likelihood ratio in the management of the young child with fever

The febrile infant is a common clinical problem for the primary health care provider. This paper employs the example of a young infant with fever to describe an important epidemiologic concept that is useful in the interpretation of diagnostic data--the likelihood ratio. The likelihood ratio expresses the odds of a given diagnostic test result occurring in a patient with (as opposed to without) the target disorder. Likelihood ratios have three properties that are helpful for clinicians: (1) The likelihoods that make up the likelihood ratio are calculated in a manner similar to sensitivity and specificity and therefore show little variation with change in disease prevalence (unlike predictive values, which change dramatically with disease prevalence). (2) Likelihood ratios can be calculated at several levels of a sign, symptom, or laboratory test. (3) Likelihood ratios can be used to shorten the list of diagnostic possibilities because the pretest "odds" X likelihood ratio = post-test "odds" of a disease. Using likelihood ratios in the practice of primary care medicine should reduce the number of patients with false-positive or false-negative results, sparing some patients needless therapy as well as minimizing the number of patients denied efficacious interventions. Support for likelihood ratios within the primary care medical community will hasten their availability in laboratories of clinical medicine.