Patient-oriented interventions to improve antibiotic prescribing practices in respiratory tract infections: a meta-analysis

Abstract

Antimicrobial resistance is a major public health issue and despite the growing awareness of this problem, antibiotic consumption remains common. Interventions geared towards the patient may be an effective means to reduce antibiotic overuse. The present study examines the effectiveness of patient-oriented interventions to promote more prudent use of antibiotics. Meta-analysis was used to evaluate the results of 28 studies describing patient-oriented intervention in terms of cognitive outcomes (attitudes and knowledge about antibiotics), use of antibiotics (self-reported by patients, prescription or dispension rates), and patient satisfaction with treatment. Our findings demonstrate relatively small but consistent positive effects on cognitive outcomes, which were not moderated by any intervention characteristic (e.g., intervention setting or type of education materials). Findings also show moderate to large positive effects on the use of antibiotics: especially interventions promoting delayed or refused prescription proved very effective in decreasing the use of antibiotics. In contrast, interventions using other methods (any type of education) to decrease the inappropriate use of antibiotics were not effective at all. Interestingly, delayed or refused prescription did not affect patient satisfaction with treatment in a negative manner. Based on these results, it is concluded that the promotion of more prudent use of antibiotics in patients is better achieved by encouraging health professionals to delay or refuse the prescription of antibiotics rather than by educating patients about the negative aspects of antibiotics.

Keywords:

• antibiotic use
• patient-oriented intervention
• meta-analysis

Acknowledgements

Bart Thoolen and Denise de Ridder were supported by a grant from the European Community FP6 Research Programme (grant number SP5A-CT-2007-044317 to the CHAMP consortium: Changing behaviour of health care professionals and the general public towards a more prudent use of antimicrobial agents). The authors acknowledge input and comment from the Champ consortium

Notes

1. The higher number of eligible studies identified in MEDLINE as compared to EMBASE and PSYCINFO probably relates to the fact that studies on antibiotics use are mostly performed in the medical setting by researchers who are employed at medical faculties and consider medical journals as their primary outlet.