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Knowledge, attitudes and practices towards antibiotic use in upper respiratory tract infections among patients seeking primary health care in Singapore.
BMC Fam Pract. 2016 11 03; 17(1):148.BF

Abstract

BACKGROUND

Patients' expectations can influence antibiotic prescription by primary healthcare physicians. We assessed knowledge, attitude and practices towards antibiotic use for upper respiratory tract infections (URTIs), and whether knowledge is associated with increased expectations for antibiotics among patients visiting primary healthcare services in Singapore.

METHODS

Data was collected through a cross-sectional interviewer-assisted survey of patients aged ≥21 years waiting to see primary healthcare practitioners for one or more symptoms suggestive of URTI (cough, sore throat, runny nose or blocked nose) for 7 days or less, covering the demographics, presenting symptoms, knowledge, attitudes, beliefs and practices of URTI and associated antibiotic use. Univariate and multivariate logistic regression was used to assess independent factors associated with patients' expectations for antibiotics.

RESULTS

Nine hundred fourteen out of 987 eligible patients consulting 35 doctors were recruited from 24 private sector primary care clinics in Singapore. A third (307/907) expected antibiotics, of which a substantial proportion would ask the doctor for antibiotics (121/304, 40 %) and/or see another doctor (31/304, 10 %) if antibiotics were not prescribed. The majority agreed "antibiotics are effective against viruses" (715/914, 78 %) and that "antibiotics cure URTI faster" (594/912, 65 %). Inappropriate antibiotic practices include "keeping antibiotics stock at home" (125/913, 12 %), "taking leftover antibiotics" (114/913, 14 %) and giving antibiotics to family members (62/913, 7 %). On multivariate regression, the following factors were independently associated with wanting antibiotics (odds ratio; 95 % confidence interval): Malay ethnicity (1.67; 1.00-2.79), living in private housing (1.69; 1.13-2.51), presence of sore throat (1.50; 1.07-2.10) or fever (1.46; 1.01-2.12), perception that illness is serious (1.70; 1.27-2.27), belief that antibiotics cure URTI faster (5.35; 3.76-7.62) and not knowing URTI resolves on its own (2.18; 1.08-2.06), while post-secondary education (0.67; 0.48-0.94) was inversely associated. Those with lower educational levels were significantly more likely to have multiple misconceptions about antibiotics.

CONCLUSION

Majority of patients seeking primary health care in Singapore are misinformed about the role of antibiotics in URTI. Agreeing with the statement that antibiotics cure URTI faster was most strongly associated with wanting antibiotics. Those with higher educational levels were less likely to want antibiotics, while those with lower educational levels more likely to have incorrect knowledge.

Authors+Show Affiliations

Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 119228, Singapore, Singapore.Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 119228, Singapore, Singapore.Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 119228, Singapore, Singapore.Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 119228, Singapore, Singapore.Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, 12 Science Drive 2, 117549, Singapore, Singapore. mark.chen.ic@gmail.com. Institute of Infectious Diseases & Epidemiology, Communicable Disease Centre, Tan Tock Seng Hospital, 308433, Singapore, Singapore. mark.chen.ic@gmail.com.Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, 12 Science Drive 2, 117549, Singapore, Singapore.Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, 12 Science Drive 2, 117549, Singapore, Singapore.Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, 12 Science Drive 2, 117549, Singapore, Singapore.Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 119228, Singapore, Singapore. Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, 12 Science Drive 2, 117549, Singapore, Singapore. Institute of Infectious Diseases & Epidemiology, Communicable Disease Centre, Tan Tock Seng Hospital, 308433, Singapore, Singapore. Lee Kong Chian School of Medicine, Nan Yang Technological University, 308232, Singapore, Singapore.Institute of Infectious Diseases & Epidemiology, Communicable Disease Centre, Tan Tock Seng Hospital, 308433, Singapore, Singapore.Institute of Infectious Diseases & Epidemiology, Communicable Disease Centre, Tan Tock Seng Hospital, 308433, Singapore, Singapore.Division of Family Medicine, Department of Medicine, University Medicine Cluster, National University Hospital System, 119228, Singapore, Singapore.Frontier Healthcare group, 400305, Singapore, Singapore.Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 119228, Singapore, Singapore. Division of Family Medicine, Department of Medicine, University Medicine Cluster, National University Hospital System, 119228, Singapore, Singapore. Frontier Healthcare group, 400305, Singapore, Singapore.Division of Family Medicine, Department of Medicine, University Medicine Cluster, National University Hospital System, 119228, Singapore, Singapore. Division of Primary Care, Raffles Medical Group, 188770, Singapore, Singapore. Duke NUS Graduate Medical School, National University of Singapore, 169857, Singapore, Singapore.Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 119228, Singapore, Singapore. Division of Family Medicine, Department of Medicine, University Medicine Cluster, National University Hospital System, 119228, Singapore, Singapore.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27809770

Citation

Pan, Darius Shaw Teng, et al. "Knowledge, Attitudes and Practices Towards Antibiotic Use in Upper Respiratory Tract Infections Among Patients Seeking Primary Health Care in Singapore." BMC Family Practice, vol. 17, no. 1, 2016, p. 148.
Pan DS, Huang JH, Lee MH, et al. Knowledge, attitudes and practices towards antibiotic use in upper respiratory tract infections among patients seeking primary health care in Singapore. BMC Fam Pract. 2016;17(1):148.
Pan, D. S., Huang, J. H., Lee, M. H., Yu, Y., Chen, M. I., Goh, E. H., Jiang, L., Chong, J. W., Leo, Y. S., Lee, T. H., Wong, C. S., Loh, V. W., Poh, A. Z., Tham, T. Y., Wong, W. M., & Lim, F. S. (2016). Knowledge, attitudes and practices towards antibiotic use in upper respiratory tract infections among patients seeking primary health care in Singapore. BMC Family Practice, 17(1), 148.
Pan DS, et al. Knowledge, Attitudes and Practices Towards Antibiotic Use in Upper Respiratory Tract Infections Among Patients Seeking Primary Health Care in Singapore. BMC Fam Pract. 2016 11 3;17(1):148. PubMed PMID: 27809770.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Knowledge, attitudes and practices towards antibiotic use in upper respiratory tract infections among patients seeking primary health care in Singapore. AU - Pan,Darius Shaw Teng, AU - Huang,Joyce Huixin, AU - Lee,Magdalene Hui Min, AU - Yu,Yue, AU - Chen,Mark I-Cheng, AU - Goh,Ee Hui, AU - Jiang,Lili, AU - Chong,Joash Wen Chen, AU - Leo,Yee Sin, AU - Lee,Tau Hong, AU - Wong,Chia Siong, AU - Loh,Victor Weng Keong, AU - Poh,Adrian Zhongxian, AU - Tham,Tat Yean, AU - Wong,Wei Mon, AU - Lim,Fong Seng, Y1 - 2016/11/03/ PY - 2015/10/15/received PY - 2016/10/21/accepted PY - 2016/11/5/pubmed PY - 2017/11/8/medline PY - 2016/11/5/entrez KW - Antibiotic use KW - Educational level KW - Primary healthcare KW - Singapore KW - Upper Respiratory Tract Infections (URTIs) SP - 148 EP - 148 JF - BMC family practice JO - BMC Fam Pract VL - 17 IS - 1 N2 - BACKGROUND: Patients' expectations can influence antibiotic prescription by primary healthcare physicians. We assessed knowledge, attitude and practices towards antibiotic use for upper respiratory tract infections (URTIs), and whether knowledge is associated with increased expectations for antibiotics among patients visiting primary healthcare services in Singapore. METHODS: Data was collected through a cross-sectional interviewer-assisted survey of patients aged ≥21 years waiting to see primary healthcare practitioners for one or more symptoms suggestive of URTI (cough, sore throat, runny nose or blocked nose) for 7 days or less, covering the demographics, presenting symptoms, knowledge, attitudes, beliefs and practices of URTI and associated antibiotic use. Univariate and multivariate logistic regression was used to assess independent factors associated with patients' expectations for antibiotics. RESULTS: Nine hundred fourteen out of 987 eligible patients consulting 35 doctors were recruited from 24 private sector primary care clinics in Singapore. A third (307/907) expected antibiotics, of which a substantial proportion would ask the doctor for antibiotics (121/304, 40 %) and/or see another doctor (31/304, 10 %) if antibiotics were not prescribed. The majority agreed "antibiotics are effective against viruses" (715/914, 78 %) and that "antibiotics cure URTI faster" (594/912, 65 %). Inappropriate antibiotic practices include "keeping antibiotics stock at home" (125/913, 12 %), "taking leftover antibiotics" (114/913, 14 %) and giving antibiotics to family members (62/913, 7 %). On multivariate regression, the following factors were independently associated with wanting antibiotics (odds ratio; 95 % confidence interval): Malay ethnicity (1.67; 1.00-2.79), living in private housing (1.69; 1.13-2.51), presence of sore throat (1.50; 1.07-2.10) or fever (1.46; 1.01-2.12), perception that illness is serious (1.70; 1.27-2.27), belief that antibiotics cure URTI faster (5.35; 3.76-7.62) and not knowing URTI resolves on its own (2.18; 1.08-2.06), while post-secondary education (0.67; 0.48-0.94) was inversely associated. Those with lower educational levels were significantly more likely to have multiple misconceptions about antibiotics. CONCLUSION: Majority of patients seeking primary health care in Singapore are misinformed about the role of antibiotics in URTI. Agreeing with the statement that antibiotics cure URTI faster was most strongly associated with wanting antibiotics. Those with higher educational levels were less likely to want antibiotics, while those with lower educational levels more likely to have incorrect knowledge. SN - 1471-2296 UR - https://www.unboundmedicine.com/medline/citation/27809770/Knowledge_attitudes_and_practices_towards_antibiotic_use_in_upper_respiratory_tract_infections_among_patients_seeking_primary_health_care_in_Singapore_ L2 - https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-016-0547-3 DB - PRIME DP - Unbound Medicine ER -