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Antibiotic overuse for acute respiratory tract infections in Sri Lanka: a qualitative study of outpatients and their physicians.
BMC Fam Pract. 2017 03 16; 18(1):37.BF

Abstract

BACKGROUND

Acute respiratory tract infections (ARTIs) are a common reason for antibiotic overuse worldwide. We previously showed that over 80% of outpatients presenting to a tertiary care hospital in Sri Lanka with influenza-like illness received antibiotic prescriptions, although almost half were later confirmed to have influenza. The purpose of this qualitative study was to assess Sri Lankan patients' and physicians' attitudes towards ARTI diagnosis and treatment.

METHODS

Semi-structured interviews were conducted with 50 outpatients with ARTIs and five physicians in the Outpatient Department (OPD) at a large, public tertiary care hospital in southern Sri Lanka. Interviews were audio-recorded, transcribed, and analyzed for themes related to ARTI diagnosis and treatment.

RESULTS

Patients frequently sought ARTI care in the public sector due to the receipt of free care and the perception that government hospitals carried a sense of responsibility for patients' health. Patients reported multiple medical visits for their illnesses of short duration and many indicated that they were seeking care in the OPD while at the hospital for another reason. While patients generally expected to receive medication prescriptions at their visit, most patients were not specifically seeking an antibiotic prescription. However, more than 70% of patients received antibiotic prescriptions at their OPD visit. Physicians incorrectly perceived that patients desired antibiotics or "capsules," a common formulation of antibiotics dispensed in this outpatient setting, and cited patient demand as an important cause of antibiotic overuse. Physicians also indicated that high patient volume and fear of bacterial superinfection drove antibiotic overuse.

CONCLUSIONS

Patients in this study were seeking medication prescriptions for their ARTIs, but physicians incorrectly perceived that antibiotic prescriptions were desired. High patient volume and fear of bacterial superinfection were also important factors in antibiotic overuse. Training of physicians regarding guideline-concordant management and dealing with diagnostic uncertainty, education of patients regarding ARTI etiology and management, and systematic changes in the public outpatient care structure may help decrease unnecessary antibiotic prescriptions for ARTIs in this setting.

Authors+Show Affiliations

Department of Medicine, Duke University School of Medicine and Duke Global Health Institute, Durham, USA. gayani.tillekeratne@dm.duke.edu.Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.Nutrition and Indigenous Medicine, Ministry of Health, Colombo, Sri Lanka.Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.Teaching Hospital Karapitiya, Galle, Sri Lanka.Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.Duke Global Health Institute, Durham, USA.Duke Global Health Institute, Durham, USA.Department of Community and Family Medicine, Duke University School of Medicine and Duke Global Health Institute, Durham, USA.Department of Medicine, Duke University School of Medicine and Duke Global Health Institute, Durham, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28302056

Citation

Tillekeratne, L Gayani, et al. "Antibiotic Overuse for Acute Respiratory Tract Infections in Sri Lanka: a Qualitative Study of Outpatients and Their Physicians." BMC Family Practice, vol. 18, no. 1, 2017, p. 37.
Tillekeratne LG, Bodinayake CK, Dabrera T, et al. Antibiotic overuse for acute respiratory tract infections in Sri Lanka: a qualitative study of outpatients and their physicians. BMC Fam Pract. 2017;18(1):37.
Tillekeratne, L. G., Bodinayake, C. K., Dabrera, T., Nagahawatte, A., Arachchi, W. K., Sooriyaarachchi, A., Stewart, K., Watt, M., Østbye, T., & Woods, C. W. (2017). Antibiotic overuse for acute respiratory tract infections in Sri Lanka: a qualitative study of outpatients and their physicians. BMC Family Practice, 18(1), 37. https://doi.org/10.1186/s12875-017-0619-z
Tillekeratne LG, et al. Antibiotic Overuse for Acute Respiratory Tract Infections in Sri Lanka: a Qualitative Study of Outpatients and Their Physicians. BMC Fam Pract. 2017 03 16;18(1):37. PubMed PMID: 28302056.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antibiotic overuse for acute respiratory tract infections in Sri Lanka: a qualitative study of outpatients and their physicians. AU - Tillekeratne,L Gayani, AU - Bodinayake,Champica K, AU - Dabrera,Thushani, AU - Nagahawatte,Ajith, AU - Arachchi,Wasantha Kodikara, AU - Sooriyaarachchi,Anoji, AU - Stewart,Kearsley, AU - Watt,Melissa, AU - Østbye,Truls, AU - Woods,Christopher W, Y1 - 2017/03/16/ PY - 2016/10/10/received PY - 2017/03/07/accepted PY - 2017/3/18/entrez PY - 2017/3/18/pubmed PY - 2017/10/25/medline KW - Antibiotics KW - Health care utilization KW - Outpatients KW - Respiratory tract infections KW - Sri Lanka SP - 37 EP - 37 JF - BMC family practice JO - BMC Fam Pract VL - 18 IS - 1 N2 - BACKGROUND: Acute respiratory tract infections (ARTIs) are a common reason for antibiotic overuse worldwide. We previously showed that over 80% of outpatients presenting to a tertiary care hospital in Sri Lanka with influenza-like illness received antibiotic prescriptions, although almost half were later confirmed to have influenza. The purpose of this qualitative study was to assess Sri Lankan patients' and physicians' attitudes towards ARTI diagnosis and treatment. METHODS: Semi-structured interviews were conducted with 50 outpatients with ARTIs and five physicians in the Outpatient Department (OPD) at a large, public tertiary care hospital in southern Sri Lanka. Interviews were audio-recorded, transcribed, and analyzed for themes related to ARTI diagnosis and treatment. RESULTS: Patients frequently sought ARTI care in the public sector due to the receipt of free care and the perception that government hospitals carried a sense of responsibility for patients' health. Patients reported multiple medical visits for their illnesses of short duration and many indicated that they were seeking care in the OPD while at the hospital for another reason. While patients generally expected to receive medication prescriptions at their visit, most patients were not specifically seeking an antibiotic prescription. However, more than 70% of patients received antibiotic prescriptions at their OPD visit. Physicians incorrectly perceived that patients desired antibiotics or "capsules," a common formulation of antibiotics dispensed in this outpatient setting, and cited patient demand as an important cause of antibiotic overuse. Physicians also indicated that high patient volume and fear of bacterial superinfection drove antibiotic overuse. CONCLUSIONS: Patients in this study were seeking medication prescriptions for their ARTIs, but physicians incorrectly perceived that antibiotic prescriptions were desired. High patient volume and fear of bacterial superinfection were also important factors in antibiotic overuse. Training of physicians regarding guideline-concordant management and dealing with diagnostic uncertainty, education of patients regarding ARTI etiology and management, and systematic changes in the public outpatient care structure may help decrease unnecessary antibiotic prescriptions for ARTIs in this setting. SN - 1471-2296 UR - https://www.unboundmedicine.com/medline/citation/28302056/Antibiotic_overuse_for_acute_respiratory_tract_infections_in_Sri_Lanka:_a_qualitative_study_of_outpatients_and_their_physicians_ L2 - https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-017-0619-z DB - PRIME DP - Unbound Medicine ER -