Health literacy gaps fuel unrealistic antibiotic expectations in primary care patients

Patients expecting antibiotics for common symptoms risk contributing to antibiotic overuse, making education on the dangers of misuse and resistance critical for both clinicians and the public.

In a recent study published in The Annals of Family Medicine, researchers investigate the predictors and prevalence of antibiotic expectations of patients with common symptoms and illnesses.

Over 93% of patients expected antibiotics for one or more common symptoms, with higher expectations observed in patients in public clinics. Lower education, insufficient health literacy, and lack of knowledge about antibiotic risks are related to increased antibiotic expectations.

The inappropriate use of antibiotics

Patients are frequently prescribed antibiotics for common viral symptoms and ailments like respiratory infections, colds/flu, and diarrhea despite clinical guidelines advising against this practice. In fact, current estimates indicate that up to 28% of antibiotic prescriptions in the United States alone are unnecessary.

Antimicrobial resistance (AMR), which is a major public health concern that threatens to collapse global healthcare systems, is primarily due to the frequent inappropriate use of antibiotics. However, reducing the inappropriate prescription of antibiotics is complex, as various factors, such as patient beliefs, knowledge, and expectations, are involved. Few studies have explored the independent effects of sociodemographic factors and antibiotic risk awareness on patient expectations for antibiotics in treating common symptoms.

About the study

In the present study, researchers assess how often patients expect antibiotics for conditions like acute diarrhea, cold/flu, sore throat, sinus infections, and bronchitis and compare the prevalence of these expectations between patients in private and public primary care systems. The researchers also identify different factors that may predict patients' expectations for antibiotics for each specific condition.

Between January 2020 and June 2021, a survey was conducted in six public primary care clinics and two private emergency departments in Harris County, Texas. Patients with diverse sociodemographic backgrounds were invited to participate in the survey through flyers, with surveys conducted in person or virtually due to coronavirus disease 2019 (COVID-19) restrictions. Individuals under 18 years of age and those unable to complete the survey were excluded from the analysis.

The survey assessed patient expectations about antibiotics through the Likert scale, which was dichotomized into expectations or no expectations. Patients' knowledge of antibiotic risks, sociodemographic factors, and health literacy were also analyzed. Affirmative responses to risk awareness questions determined knowledge of antibiotic risks, whereas a validated screening tool was used to measure health literacy.

Statistical comparisons between patient characteristics and antibiotic expectations were performed using chi-square tests. Multivariable logistic regression analysis was also used to assess the impact of education, knowledge of antibiotic risks, healthcare system, and health literacy on antibiotic expectations.

Study findings

Among the surveyed patients, 84% believed that antibiotics would help treat bronchitis, whereas 72%, 64%, 66%, and 36% expected antibiotics to be prescribed for treating sinus infections, cold/flu, sore throat, and diarrhea, respectively. Public clinic patients were almost two-fold more likely to expect antibiotics for diarrhea, sore throat, and cold/flu as compared to private clinic patients, with odds ratios (ORs) of 1.8, 2.2, and 1.5, respectively.

Lower education predicted higher antibiotic expectations for diarrhea. Likewise, patients lacking a high school diploma were twice as likely to expect antibiotics as those with a college education.

About 37% of patients lacked knowledge of antibiotic risks, which significantly increased their expectations for antibiotics in treating diarrhea and cold/flu, with ORs of 1.6 and 2.9, respectively, and, to a lesser extent, sore throat symptoms.

These findings align with those of previous studies. However, the current study is limited by the lack of generalizability to less diverse urban areas, the potential complexity of public clinic patients, social desirability bias, and the possible influence of the COVID-19 pandemic on antibiotic expectations.

Conclusions

Differences in patient education, health literacy, knowledge of antibiotic risks, and the healthcare system contribute to unrealistic patient expectations regarding antibiotic treatment for common symptoms. To address this issue, future stewardship interventions should focus on educating patients about which symptoms antibiotics can effectively treat and highlighting both individual and societal risks associated with antibiotic use.

Building on these findings, the current study's researchers aim to create an antibiotic education tool for patients and clinicians to promote appropriate antibiotic use and facilitate discussions about non-antibiotic treatment options.

Journal reference:

• Laytner, L. A., Trautner, B. W., Nash, S., et al. (2024). Lack of Knowledge of Antibiotic Risks Contributes to Primary Care Patients’ Expectations of Antibiotics for Common Symptoms. The Annals of Family Medicine 22(5);421-425 (2024). doi:10.1370/afm.3161.