Docs give in to patient prescribing pressure

January 1, 2002

Pharmaceutical Representative

Patients find subtle and overt ways to persuade physicians to prescribe unnecessary antimicrobials for the treatment of respiratory illnesses.

Patients find subtle and overt ways to persuade physicians to prescribe unnecessary antimicrobials for the treatment of respiratory illnesses, according to a report in the Journal of Family Practice (vol. 50, no. 10).

The study found that a third of the patients who visited their family practice physician because of symptoms of an acute respiratory-tract infection described that illness as unusually severe or implied a need for help in getting well. For 80% of these patients, the physician responded by prescribing unnecessary antimicrobial therapy, the researchers determined.

A smaller proportion of patients (13%) told their physician that an antimicrobial they had used in the past had worked well to treat a similar illness. In 97% of these cases, the physician prescribed an unnecessary antimicrobial for the new illness.

The three-year study focused on 298 outpatient visits made to 18 community-based family practices in Nebraska. Field researchers directly observed and recorded data on the patient-physician encounters. Afterward, the researchers determined whether the decision to prescribe an antimicrobial was made in accordance with guidelines from the Centers for Disease Control and Prevention.

Too much prescribing

Physicians who participated in the study prescribed an antimicrobial during 68% of the observed visits. Eighty percent of these prescriptions, the researchers determined, did not conform to the CDC's antimicrobial-use criteria.

During 6% of the visits described in the study, patients explicitly asked the physician to prescribe an antimicrobial drug. In 93% of these cases, the physician granted the request.

Potentially manipulative patient behaviors that did not significantly influence prescribing included emphasis of the symptoms suggestive of a bacterial infection and offering of a "candidate diagnosis" to the physician. The researchers described only one type of patient behavior - description of symptoms with no embellishment - as not putting pressure on a physician to prescribe an antimicrobial.

Children under 16 years of age, who accounted for 36% of the observed visits, were significantly less likely than adults to receive a prescription for an inappropriate antimicrobial therapy. PR

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