An assessment of factors influencing the prescribing of antibiotics in Acute Respiratory Illness: A questionnaire study

Introduction: Non-clinical factors are major determinants in the decision to prescribe medication. This study was prompted by the impression that Primary Care Physicians in South Africa are constantly under pressure to prescribe antibiotics. The objective was to assess patients' views and expectations, regarding their need for antibiotic therapy, and compare this with the doctor's perception of this expectation. Study Design: Questionnaire study involving patients and general practitioners. Population: General practitioners and their patients in a sub-set of the Durban Metropole, Kwa-Zulu Natal, South Africa. Outcomes Measured: The patient's views and expectations regarding the need for antibiotics, the doctor's perceptions of these expectations and the relationship between all these factors and the actual prescribing of antibiotics. Results: Factors most strongly associated with prescribing were the patient's opinion that antibiotics were required, his/her expectation of receiving them and the doctor's perception of this expectation. Patients aware of the dangers, to the community, of over-prescribing, expected antibiotics 64% of the time as opposed to 90% of the patients who were unaware of the dangers. Conclusion: Several non-clinical factors, such as patient expectation and doctors' perception of this expectation, were associated with antibiotic prescribing. However prescribing was also strongly related to the doctor's view that an antibiotic was indicated. The expectation of receiving an antibiotic prescription, but not the actual receipt of such a prescription, was less among patients who were aware of the possible dangers to the community of antibiotic over-use. SA Fam Pract 2003;45(6):20-24 Keywords: Respiratory illness, antibiotics, physicians, family, patient educatio