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Does clinical error contribute to unnecessary antibiotic use?
1Mt. Sinai Family Medicine Centre, Toronto, Ontario, Canada. wmcisaac@mtsinai.on.ca
Abstract:
Patient expectations and physician attitudes are often cited as factors in the overuse of antibiotics. This study examined whether clinical error might also be important. In treating 517 patients with sore throat, family physicians estimated the probability that group A streptococcus infection was present. Two thirds of antibiotics prescribed were to culture-negative patients and therefore considered unnecessary. Physicians overestimated the probability that a group A streptococcal infection was present by an average 33.2% in these cases, compared with 6.9% otherwise (p < 0.001). The rate of unnecessary prescribing was 5.1% when the physician estimate differed from the true probability of a group A streptococcal infection by <10%, 16.0% for an error of 10-29%, 35.6% for an error of 30-49%, and 78.3% when the chance of the infection was overestimated by 50% or more. Clinical error in estimating the likelihood of group A streptococcal infection probably contributes to unnecessary antibiotic use in patients with sore throat.
Insights
Physician overestimation of group A streptococcus infection likelihood leads to unnecessary antibiotic prescriptions for sore throats. Clinical errors in probability assessment significantly correlate with increased antibiotic overuse in primary care settings.
Area of Science:
- General Practice
- Infectious Disease Epidemiology
- Clinical Decision Making
Background:
- Antibiotic overuse is a significant public health concern, often attributed to patient expectations and physician attitudes.
- The role of clinical error in the inappropriate prescribing of antibiotics, particularly for common infections like sore throat, remains less explored.
Purpose of the Study:
- To investigate the contribution of clinical error in physicians' probability estimates to unnecessary antibiotic prescribing for patients presenting with sore throat.
- To quantify the relationship between the accuracy of physicians' diagnostic probability estimates and the rate of unnecessary antibiotic prescriptions.
Main Methods:
- A prospective study involving 517 patients with sore throat treated by family physicians.
- Physicians estimated the probability of group A streptococcus infection for each patient.
- Prescribing patterns and diagnostic outcomes (culture results) were analyzed in relation to physicians' probability estimates.
Main Results:
- Two-thirds of prescribed antibiotics were for culture-negative cases, indicating unnecessary use.
- Physicians significantly overestimated the probability of group A streptococcus infection by an average of 33.2% in culture-negative cases, compared to 6.9% in culture-positive cases (p < 0.001).
- The rate of unnecessary antibiotic prescribing increased substantially with the magnitude of physician overestimation, ranging from 5.1% for errors <10% to 78.3% for errors ≥50%.
Conclusions:
- Clinical error in estimating the likelihood of group A streptococcus infection is a significant factor contributing to the overuse of antibiotics in patients with sore throat.
- Improving the accuracy of clinical judgment in diagnosing streptococcal pharyngitis could reduce unnecessary antibiotic prescribing.
- This study highlights the need for enhanced diagnostic training and decision support tools for primary care physicians to mitigate clinical errors and curb antibiotic resistance.