Care-Seeking Behavior for Upper Respiratory Infections

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Original Research

Care-Seeking Behavior for Upper Respiratory Infections

J Fam Pract. 2000 October;49(10):915-920

References

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The overall rate at which antibiotics were prescribed for these patients (65%) is similar to that reported by most other studies.^1,4-5 One of the principal aims of the guideline that led to our study was reduction of unnecessary antibiotic use, along with encouragement for initial telephone care instead of office visits for uncomplicated cases.¹⁷ The guideline also recommended contact only under these conditions: worsening or new symptoms after the first 3 to 5 days and lack of improvement after 7 to 10 days (children) or 14 days (adults).

However, an impact study of that guideline’s implementation by O’Connor and colleagues¹⁵ found that patients who received telephone advice were 50% more likely to come in for an office visit after guideline implementation than before. Also, although antibiotic use at initial contact for the diagnosis of a URI fell from 24% to 16%, the likelihood of receiving an antibiotic during a 21-day follow-up period actually rose after the implementation of the guideline. O’Connor and coworkers concluded that the failure of the guideline implementation to achieve its aims was the result of conflict with patient expectations and desires. Because only those adult patients with illnesses of more than 5 days’ duration reported desires for antibiotic prescriptions at a rate as high as that for actual use, patient desires do not seem to be the only driver of antibiotic use.

Limitations

Our analysis is limited by its inability to separate those who called from those who visited, although the usual concurrence of those events makes any such study difficult. It is also limited in that it is focused entirely on patient responses to a telephone survey, with no additional information about the illness diagnoses, care, or outcomes from chart audits.

Conclusions

There were no obvious explanations in our survey results for the decision by a sizable minority of those seeking medical attention for URI symptoms to do so very soon after the onset of their symptoms. Clinicians will need to elicit and address the chief concerns and needs of each patient they see, regardless of the timing of that contact. It is possible that providing more general information to potential patients about the nature and care of URIs will help health care systems delay or reduce the perceived need of these patients for such contacts, but that remains to be proved. It is time for researchers to move into trials of various intervention strategies that may reduce both unnecessary visits and the associated antibiotic use.

Acknowledgments

Our project was supported by a grant from the Institute for Clinical Systems Improvement, Minneapolis, Minnesota. We are also grateful to the clinic staff who cooperated with our need to identify patients making contact for their URI symptoms.