Survey results revealed that patients were more likely to be satisfied with their care when visiting a general practice that frequently prescribed antibiotics, according to recent data published in the British Journal of General Practice.
The findings underscore the rising trend of antibiotic prescribing in primary care, which increased 6% in England between 2010 and 2013, according to Mark Ashworth, DM, MRCP, FRCGP, from the department of primary care and public health services at King’s College London School of Medicine, and colleagues.
“The cornerstone of good general practice has long been recognized as lying in the quality of the relationship between doctor and patient,” Ashworth and colleagues wrote. “However, pleasing the patient is not always consistent with providing good-quality care. [General practitioners (GPs)] are well aware that patients may demand an antibiotic when it is not judged clinically appropriate.”
Results from a prior survey found that 55% of GPs prescribed antibiotics because they felt pressured, 45% inappropriately prescribed antibiotics for a viral infection, and 44% admitted to prescribing an antibiotic so the patient would leave the consulting room.
Prescribing’s influence on patient satisfaction
To determine whether antibiotic prescribing had an impact on patient satisfaction, Ashworth and colleagues assessed results from the 2012 General Practice Patient Survey that included data from nearly all general practices (95.5%) in England (n = 7,800). The results were adjusted for patient profile, the number of health care providers in each practice, the age and sex of providers and the providers’ experience.
More than 33.7 million antibiotics were prescribed to 53.8 million patients, according to the researchers. The average duration an antibiotic was prescribed for was 1.15 days per patient.
Frequent antibiotic prescribing was a significant predictor of positive survey results on all doctor and practice satisfaction scores, the researchers said. Responses to the overall experience of general practice surgery yielded the lowest association between antibiotic prescribing and satisfaction (regression coefficient = 1.98; 95% CI, 1.43-2.53), while how a GP treated a patient with care and concern yielded the highest association (regression coefficient = 4.07; 95% CI, 3.49-4.65).
Antibiotic prescribing was the highest indicator for overall satisfaction compared with all other prescriptions, including antidepressants, hypnotics, antipsychotics and low-cost statins (P < .0001). The researchers estimated that a 25% reduction in antibiotic prescribing would reduce satisfaction scores by 0.5% to 1%.
Despite these findings, Ashworth and colleagues wrote that GPs often overestimate the relationship between patient satisfaction and antibiotic prescribing.
In a separate survey conducted in the United States between 2012 and 2013, 54% of health care providers said they thought their patients expected an antibiotic to treat a viral illness; however, only 26% of all consumers said they anticipated a prescription. Forty-two percent of consumers said they expected reassurance from their physician instead of a prescription.
The results also revealed cultural differences in antibiotic knowledge. Hispanic consumers were more likely to believe that antibiotics could treat cold symptoms and were less aware of antibiotic resistance. Although 41% of Hispanic consumers expected an antibiotic during an office visit, they were more likely to expect recommendations for symptom relief (58%). These findings indicated that provider counseling, not an antibiotic prescription, is critical for consumer satisfaction, the researchers wrote.
“Although small-scale studies have shown that dissatisfaction about not receiving an antibiotic can be offset if the patient feels that they have been listened to or carefully examined, the extent to which this applies to all antibiotic prescribing is not known,” Ashworth and colleagues concluded. “This has particular importance to the growing problem of antibiotic resistance in primary care. GPs who wish to achieve more appropriate and targeted prescription of antibiotics will be supported by a better understanding of how patient satisfaction can be maintained in consultations when antibiotics are not prescribed.” – by Stephanie Viguers
Ashworth M, et al. Br J Gen Pract. 2015;doi:10.3399/bjgp15X688105.
Cole A. BMJ. 2014;doi:10.1136/bmj.g5238.
Watkins LKF, et al. MMWR Morb Mortal Wkly Rep. 2015;64:767-770.
Disclosure: The researchers report no relevant financial disclosures.