Gaps in health literacy fuel unrealistic antibiotic expectations among primary care patients

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

Study: Lack of knowledge about the risks of antibiotics contributes to primary care patients’ expectations of antibiotics for common symptoms. Image credits: New Africa / Shutterstock.com

From a recent study published in The Annals of Family Medicine, researchers are investigating the predictors and prevalence of antibiotic expectations of patients with common symptoms and diseases.

More than 93% of patients expected antibiotics for one or more common symptoms, with higher expectations observed among patients in public clinics. A lower level of education, insufficient health literacy and a lack of knowledge about the risks of antibiotics are associated with higher antibiotic expectations.

The incorrect use of antibiotics

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

Antimicrobial resistance (AMR), a major public health problem that threatens to collapse global healthcare systems, is mainly due to the frequent inappropriate use of antibiotics. However, reducing inappropriate antibiotic prescribing is complex as it involves several factors, such as patients’ beliefs, knowledge and expectations. Few studies have examined the independent effects of sociodemographic factors and antibiotic risk awareness on patients’ expectations of antibiotics in the treatment of common symptoms.

About the study

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

A study was conducted between January 2020 and June 2021 at six public primary care clinics and two private emergency departments in Harris County, Texas. Patients from diverse sociodemographic backgrounds were invited via flyers to participate in the survey, with surveys conducted in person or virtually due to coronavirus disease 2019 (COVID-19) restrictions. Persons under the age of 18 and persons who could not complete the survey were excluded from the analysis.

The survey assessed patients’ expectations about antibiotics via the Likert scale, which was divided 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, while 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.

Findings of the study

Of patients surveyed, 84% believed antibiotics would help treat bronchitis, while 72%, 64%, 66% and 36% expected antibiotics to be prescribed to treat sinus infections, cold/flu, sore throat and diarrhea, respectively. Patients in public clinics expected almost twice as many antibiotics for diarrhea, sore throat and cold/flu compared to patients in private clinics, with odds ratios (ORs) of 1.8, 2.2 and 1.5, respectively.

Lower education predicted higher antibiotic expectations for diarrhea. Similarly, patients without a high school diploma were twice as likely to expect antibiotics as patients with a college education.

Approximately 37% of patients had no knowledge of the risks of antibiotics, significantly increasing their expectations for antibiotics in the treatment of diarrhea and cold/flu, with ORs of 1.6 and 2.9, respectively, and, to a lesser extent, symptoms of sore throat.

These findings are consistent with those from previous studies. However, current research is limited by the lack of generalizability to less diverse urban areas, the potential complexity of patients in public clinics, social desirability biases, and the potential influence of the COVID-19 pandemic on antibiotic expectations.

Conclusions

Disparities 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 researchers of the current study aim to create an antibiotic education tool for patients and physicians to promote appropriate antibiotic use and facilitate discussions about non-antibiotic treatment options.