Family Practice, Vol 15, 244-251, Copyright © 1998 by World Organization of Family Doctors
R Kawamoto, Y Asai, N Nago, M Okayama, J Mise and M Igarashi
OBJECTIVE: This study aimed to examine the factors affecting prescription
of antibiotics for acute bronchitis in ambulatory care settings in Japan.
METHOD: A prospective study was conducted on 92 physicians engaged in
primary care regarding their prescription behaviour for a series of 20 new
patients with acute respiratory diseases seen during November 1996 and the
background factors affecting the behaviour. RESULTS: A total of 1755
patients were registered during the study period, 302 (17.2%) of whom were
diagnosed with acute bronchitis and 1165 (66.4%) with upper respiratory
tract infection. Independent background factors related to diagnosis of
acute bronchitis included self-care prior to visit (odds ratio 1.93, 95% CI
1.33-2.80), complaints such as cough (8.80, 4.77-16.2), sputum (2.24,
1.59-3.14) and purulent sputum (6.47, 3.02-13.9). The odds ratio was high
in patients with more severe findings of the chest (5.00, 3.64-6.85), given
chest X-ray (2.68, 1.33-5.38) while it was low in those feeling cold (0.68,
0.48-0.96), and those with a sore throat (0.63, 0.45-0.90), nasal symptoms
(0.75, 0.54-1.04) and more severe findings of the pharynx (0.74,
0.58-0.92). In those with an upper respiratory tract infection, the odds
ratio was high for complaints such as feeling cold (1.51, 1.11-2.05) and
nasal symptoms (1.39, 1.04-1.86), while it was low for complaints such as
cough (0.67, 0.48-0.95), sputum (0.43, 0.30- 0.62), purulent sputum (0.19,
0.08-0.44), wheeze (0.34, 0.13-0.92), in those with more severe findings of
the tonsil (0.36, 0.29-0.44) and the chest (0.30, 0.19-0.47) and given
chest X-rays (0.29, 0.12-0.66). For acute bronchitis, antibiotics were
administered to 67.5% and symptomatic therapy concurrently given to 64.9%.
As for independent background factors related to prescription of
antibiotics for acute bronchitis, the odds ratio was higher in physicians
denying the efficacy of antibiotics for treating a cold (4.58, 1.94-10.8),
and the patients with complaints such as purulent sputum (22.9,
2.66-197.2), more severe findings of the pharynx (2.26, 1.34-3.79) and of
the chest (2.73, 1.53-4.88), and those who had a body temperature
measurement taken (4.42, 1.71-11.4) and a chest X-ray (6.11, 1.07-34.9),
but was lower in those complaining of chills (0.16, 0.04-0.66) and
diarrhoea (0.11, 0.01-1.11). CONCLUSIONS: A majority of patients receiving
medical care for acute bronchitis are given an unnecessary antibiotic
prescription. The result of this study may be useful for the finding of
appropriate forms of intervention for changing physicians' prescription
behaviour.
ORIGINAL CLINICAL RESEARCH
A study of clinical features and treatment of acute bronchitis by Japanese primary care physicians
Department of Internal Medicine, Nomura Municipal Hospital, Ehime, Japan.
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