Do back-up antibiotic prescriptions for the treatment of common respiratory symptoms alter fill rates and patient satisfaction?

BACKGROUND: One avenue to reduce the overprescribing of antibiotics for common respiratory symptoms is to use back-up antibiotic prescriptions with instructions to have them filled only if the condition does not improve or gets worse. This study investigated the level of patient satisfaction with medical care and the 7-day fill rate with the use of back-up antibiotic prescriptions for common respiratory symptoms.

POPULATION STUDIED: The authors of study evaluated patients with common respiratory symptoms presenting to 1 of 3 family practice clinics during the first 4 months of 1999. The prescribing clinicians included 19 family medicine physicians, 9 family medicine residents, and 2 physician extenders. Patients were enrolled in the study if they had chest, sinus, or head congestion; fever; headache; sore throat; or cough. Patients presenting with only one dominant symptom or physical finding were excluded. The average age or other usual demographics of the patients were not provided. Patients were enrolled from a primary care outpatient population, and therefore the results are likely to be applicable to the family practice setting. Of the 947 patients enrolled, 441 (46.6%) did not receive a prescription for an antibiotic, 220 (23.2%) received an immediate-fill prescription, and 286 (30.2%) received a back-up prescription.

STUDY DESIGN AND VALIDITY: The authors performed a prospective observational study on the use of back-up antibiotic prescriptions for patients presenting with or desiring treatment for common respiratory symptoms. The decision to provide an immediate versus back-up prescription was left to the discretion of the treating clinician. A survey was completed by each clinician to assess demographics, clinical need for antibiotics, and the type of prescription if one was provided (immediate fill or back up). Patients were instructed to fill the back-up prescription only if their condition did not improve or got worse. Those given a back-up prescription were provided a survey to be completed and mailed back 7 days after their visit. Those not completing the survey were contacted by phone. The patient survey assessed satisfaction with care, their perceived need for antibiotic therapy before the visit, whether the back-up prescription had been filled, and if additional medical care was sought for the same complaint. The time frame for filling the back-up prescription was left to the discretion of the prescriber and patient. The study is limited by the method of verifying prescription-filling (self-report by the patients). Also, the decision to use a back-up prescription was left to the treating clinician rather than randomly assigning patients.

OUTCOMES MEASURED: The authors evaluated patient satisfaction and prescription fill rates associated with the use of back-up antibiotic prescriptions.

RESULTS: Of the 255 patients completing the survey, 245 (96.1%) were satisfied with their medical care. Most patients (76.1%) receiving a back-up prescription believed they would need an antibiotic for their symptoms. The 7-day fill rate of the back-up prescriptions provided was 50.2%. Absolute reduction in antibiotic usage, assuming that all patients getting back-up prescriptions would have received an immediate-fill prescription, was 15%. Twenty-three patients (9%) required additional medical care; 74% of these patients (n=17) had their back-up prescription filled.