Calling Acute Bronchitis a Chest Cold
Background: Overuse of antibiotics for acute respiratory infections is an important public health problem and occurs in part because of pressure on physicians by patients to prescribe them. We hypothesized that if acute respiratory infections are called "chest colds" or "viral infections" rather than "bronchitis," patients will be satisfied with the diagnosis and more satisfied with not receiving antibiotics.
Methods: Family medicine patients were presented with a written scenario describing a typical acute respiratory infection where they were given one of 3 different diagnostic labels: chest cold, viral upper respiratory infection, and bronchitis, followed by a treatment plan that excluded antibiotic treatment. Data was analyzed for satisfaction with the diagnosis and treatment plan based on the diagnostic label. A total of 459 questionnaires were collected.
Results: Satisfaction (70%, 63%, and 68%) and dissatisfaction (11% 13%, and 13%) with the diagnostic labels of cold, viral upper respiratory infection, and bronchitis, respectively, showed no difference (χ = 0.368, P = .832). However, more patients were dissatisfied with not receiving an antibiotic when the diagnosis label was bronchitis. A total of 26% of those that were told they had bronchitis were dissatisfied with their treatment, compared with 13% and 17% for colds and viral illness, respectively, (χ = 9.380, P = .009). Binary logistic regression showed no difference in satisfaction with diagnosis for educational attainment, age, and sex (odds ratio (OR) = 1.09, 1.00, 0.98, respectively), or for satisfaction with treatment (OR = 1.1, 1.02, 1.00, respectively).
Conclusions: Provider use of benign-sounding labels such as chest cold when a patient presents for care for an acute respiratory infection may not affect patient satisfaction but may improve satisfaction with not being prescribed an antibiotic.
Antibiotic resistance is an important public health problem, and inappropriate antibiotic prescribing by primary care practitioners for acute respiratory infections (ARI) is a contributing factor. No universal definition for ARI exists, although the term ARI is generally applied to a self-limited upper respiratory illness associated with some or all the following symptoms: cough, nasal congestion, runny nose, sinus pressure, fever, and sore throat. Depending on the predominate symptom, the illness may be called pharyngitis, upper respiratory infection, sinusitis, or acute bronchitis when the predominant symptom is cough. Despite consistent evidence from randomized trials that antibiotics are ineffective for most patients with ARIs, there is still considerable antibiotic overprescribing. Combined National Ambulatory Medical Care Survey data from 2001 and 2002 show that 48.3% of patients presenting for office care to family physicians and general internists who have a diagnosis of upper respiratory infection received a prescription for an antibiotic, as did 58.7% of those diagnosed with acute bronchitis. (Special analysis performed for this study by David Woodwell from the National Center for Health Statistics, March 2005.). The antibiotic-prescribing rate for acute bronchitis has not changed from 1999 when 59% of adults in community-based outpatient practices received an antibiotic prescription for acute bronchitis.
Patient pressure plays a role in antibiotic overprescribing. Bauchner et al found that 54% of pediatricians felt parental pressure to prescribe antibiotics inappropriately. This pressure is often effective. Hamm et al found that when patients wanted antibiotics for acute respiratory infections, physicians prescribed them 77% of the time, but they prescribed them only 29% of the time when the patient did not ask for an antibiotic.
One possible way to decrease antibiotic prescribing for acute bronchitis would be to reduce patient pressure on physicians to prescribe them. This might be accomplished through patient education, but it is also possible that "reframing" the seriousness of the condition by using a more benign label such as "chest cold" rather than "acute bronchitis" will reduce patient expectations for an antibiotic.
We hypothesized that when presented with a scenario describing acute bronchitis, patients will be as satisfied with receiving the diagnosis of chest cold as they would be if they had received a diagnosis of either bronchitis or viral upper respiratory infection. Furthermore, we hypothesized that patients will be more satisfied with not receiving a prescription for an antibiotic if they are told they have a chest cold rather than bronchitis.
Background: Overuse of antibiotics for acute respiratory infections is an important public health problem and occurs in part because of pressure on physicians by patients to prescribe them. We hypothesized that if acute respiratory infections are called "chest colds" or "viral infections" rather than "bronchitis," patients will be satisfied with the diagnosis and more satisfied with not receiving antibiotics.
Methods: Family medicine patients were presented with a written scenario describing a typical acute respiratory infection where they were given one of 3 different diagnostic labels: chest cold, viral upper respiratory infection, and bronchitis, followed by a treatment plan that excluded antibiotic treatment. Data was analyzed for satisfaction with the diagnosis and treatment plan based on the diagnostic label. A total of 459 questionnaires were collected.
Results: Satisfaction (70%, 63%, and 68%) and dissatisfaction (11% 13%, and 13%) with the diagnostic labels of cold, viral upper respiratory infection, and bronchitis, respectively, showed no difference (χ = 0.368, P = .832). However, more patients were dissatisfied with not receiving an antibiotic when the diagnosis label was bronchitis. A total of 26% of those that were told they had bronchitis were dissatisfied with their treatment, compared with 13% and 17% for colds and viral illness, respectively, (χ = 9.380, P = .009). Binary logistic regression showed no difference in satisfaction with diagnosis for educational attainment, age, and sex (odds ratio (OR) = 1.09, 1.00, 0.98, respectively), or for satisfaction with treatment (OR = 1.1, 1.02, 1.00, respectively).
Conclusions: Provider use of benign-sounding labels such as chest cold when a patient presents for care for an acute respiratory infection may not affect patient satisfaction but may improve satisfaction with not being prescribed an antibiotic.
Antibiotic resistance is an important public health problem, and inappropriate antibiotic prescribing by primary care practitioners for acute respiratory infections (ARI) is a contributing factor. No universal definition for ARI exists, although the term ARI is generally applied to a self-limited upper respiratory illness associated with some or all the following symptoms: cough, nasal congestion, runny nose, sinus pressure, fever, and sore throat. Depending on the predominate symptom, the illness may be called pharyngitis, upper respiratory infection, sinusitis, or acute bronchitis when the predominant symptom is cough. Despite consistent evidence from randomized trials that antibiotics are ineffective for most patients with ARIs, there is still considerable antibiotic overprescribing. Combined National Ambulatory Medical Care Survey data from 2001 and 2002 show that 48.3% of patients presenting for office care to family physicians and general internists who have a diagnosis of upper respiratory infection received a prescription for an antibiotic, as did 58.7% of those diagnosed with acute bronchitis. (Special analysis performed for this study by David Woodwell from the National Center for Health Statistics, March 2005.). The antibiotic-prescribing rate for acute bronchitis has not changed from 1999 when 59% of adults in community-based outpatient practices received an antibiotic prescription for acute bronchitis.
Patient pressure plays a role in antibiotic overprescribing. Bauchner et al found that 54% of pediatricians felt parental pressure to prescribe antibiotics inappropriately. This pressure is often effective. Hamm et al found that when patients wanted antibiotics for acute respiratory infections, physicians prescribed them 77% of the time, but they prescribed them only 29% of the time when the patient did not ask for an antibiotic.
One possible way to decrease antibiotic prescribing for acute bronchitis would be to reduce patient pressure on physicians to prescribe them. This might be accomplished through patient education, but it is also possible that "reframing" the seriousness of the condition by using a more benign label such as "chest cold" rather than "acute bronchitis" will reduce patient expectations for an antibiotic.
We hypothesized that when presented with a scenario describing acute bronchitis, patients will be as satisfied with receiving the diagnosis of chest cold as they would be if they had received a diagnosis of either bronchitis or viral upper respiratory infection. Furthermore, we hypothesized that patients will be more satisfied with not receiving a prescription for an antibiotic if they are told they have a chest cold rather than bronchitis.