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Does clinical error contribute to unnecessary antibiotic use?
1Mt. Sinai Family Medicine Centre, Toronto, Ontario, Canada. wmcisaac@mtsinai.on.ca
Summary
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.