K.N.HO1, Z. HUANG1, Y. WENG1, A. CHOW1
Tan Tock Seng Hospital1
Upper respiratory tract infections(URTI) are predominantly(90%) due to viral aetiologies. However, up to one-third of patients who attended the emergency department for URTI have been prescribed antibiotics. We examined the factors associated with high antibiotic prescribing rates for URTI among junior physicians.
We conducted a cross-sectional survey among 171 junior physicians working at Tan Tock Seng Hospital’s ED, November 2019–February 2021. The questionnaire comprised 23 and 29 items on five-point Likert scales(strongly agree to strongly disagree) on antibiotic prescribing attitudes and behaviour, respectively. Principle components analysis was performed to derive the latent structure subsequently applied in the multivariable logistic regression model to assess independent factors associated with high antibiotic prescribing rates (self-reported antibiotic prescribing rate of ≥10% for URTI patients).
One-in-three (32.2%) physicians reported prescribing antibiotics in ≥10% for URTI patients. We identified four latent factors related to antibiotic prescribing attitudes and three to antibiotic prescribing behaviour. After adjusting for years of clinical practice, prescribing antibiotics based on patients’ clinical factors(AOR:2.32, 95%CI(1.50, 3.60), P<0.001) including age>65, immunocompromised state, borderline diagnosis of bacterial URTI, and re-attendance for URTI; perception that patients attending at the ED were demanding about their treatment(AOR:2.09, 95%CI(1.20, 3.62), P=0.009); and attending to a higher proportion of URTI patients(AOR:1.99, 95%CI(1.26, 3.14), P=0.003) were significantly associated with high antibiotic prescribing rates.
Patients’ clinical factors and physicians’ perception that patients were demanding were associated with high antibiotic prescribing rates for URTI. Empowering junior physicians in effective patient communications and clinical decision support tools may help reduce antibiotic prescribing rates.