09 Patients receiving a subsequent consultation were more likely to expect an

09 patients receiving a subsequent consultation were

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95% CI for the difference −1% to 17%, p=0.09). Patients receiving a subsequent consultation were more likely to expect an antibiotic (37%) compared with 31% receiving their first consultation; however, this difference was not statistically significant (difference 6%, 95% CI for the difference −3% to 15%, p=0.20). No significant patterns were observed in the expectation of antibiotics by age group (see online supplementary table D). Differences between patient expectation, expecting an antibiotic and symptom presented Patient expectations for each symptom are described in table 2 . For each symptom presented, patient expec- tations of further examination, information or reassur- ance were similar, with approximately half those who presented with each symptom reporting an expectation to receive these treatments. A large proportion of patients presenting with symptoms of an earache (67%) or cough (65%) reported expecting to receive pain relief. A large proportion of patients presenting with sinusitis (60%) or Table 2 Patient expectations for each symptom Symptom* Patient expectation Further examination Information Reassure Pain relief Nose drops Cough medicine Referral Earache (n=64, 14.7%) 39 (60.9) 34 (53.1) 30 (46.9) 43 (67.2) 6 (9.4) 23 (35.9) 0 (0.0) Sinuses (n=105, 24.1%) 53 (50.5) 56 (53.3) 53 (50.5) 47 (44.8) 14 (13.3) 63 (60.0) 5 (4.8) Common cold (n=114, 26.2%) 64 (56.1) 54 (47.4) 62 (54.4) 53 (46.5) 10 (8.8) 64 (56.1) 5 (4.4) Throat Ache (n=202, 46.4%) 104 (51.5) 99 (49.0) 96 (47.5) 115 (56.9) 13 (6.4) 101 (50.0) 8 (4.0) Cough (n=314, 72.2%) 164 (52.2) 159 (50.6) 161 (51.3) 109 (34.7) 19 (6.1) 195 (62.1) 12 (3.8) Other (n=169, 38.9%) 104 (61.5) 99 (58.6) 119 (70.4) 59 (34.9) 9 (5.3) 64 (37.9) 8 (4.7) Overall expectation† 528 501 521 426 71 510 38 Counts (%) presented. *Represents those who presented with symptom (yes response). †As many patients presented with multiple symptoms, the count exceeds the number of patients surveyed. Figure 1 Patient overall expectations. on 16 February 2019 by guest. Protected by copyright. BMJ Open: first published as 10.1136/bmjopen-2018-025396 on 15 February 2019. Downloaded from
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5 O'Connor R, et al . BMJ Open 2019; 9 :e025396. doi:10.1136/bmjopen-2018-025396 Open access cough (62%) symptoms reported expecting to receive cough medication. Table 3 presents differences in antibiotic expectations. Patients presenting with symptoms of an earache (44%) or throat ache (39%) were most likely to expect antibi- otics. The majority of patients across all symptoms where ‘unsure’ whether they would require antibiotics. DISCUSSION Our finding that 34% of those attending an OOH centre with acute URTI symptoms expected to be prescribed antibiotics prior to seeing the doctor is clinically relevant. The international literature over the last 20 years indi- cates that patient expectation for antibiotics for manage- ment of acute URTI varies from 10% (47) to 74%. 65 In our study, patient expectation for antibiotic treatment ranks third lowest in this literature and second lowest among studies published in the last 10 years. In a quali- tative study, Dempsey et al reported a recent decrease in demand for antibiotics for acute bronchitis 58 ; however, continued significant demand for antibiotics for acute URTI is evident. This is illustrated in online supplemen- tary Table E.
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