Does diagnostic uncertainty increase antibiotic prescribing in primary care?

Area of Science:

• Primary Care Medicine
• Clinical Decision-Making
• Antibiotic Stewardship

Background:

• Diagnostic uncertainty is a common challenge in primary care.
• Physicians' and patients' tolerance of uncertainty influences clinical decisions.
• Antibiotic overuse remains a significant public health concern.

Purpose of the Study:

• To investigate the link between diagnostic uncertainty factors and antibiotic prescribing in primary care.
• To analyze how physicians' and patients' tolerance of uncertainty affects antibiotic use for specific conditions.

Main Methods:

• A questionnaire survey of 327 physicians assessed diagnostic uncertainty and tolerance.
• Analysis of 207,804 antibiotic prescriptions for upper respiratory tract infections, acute tonsillitis, and pneumonia.
• Two-level logistic regression modeling to determine associations.

Main Results:

• Increased perceived diagnostic uncertainty correlated with higher antibiotic prescribing for upper respiratory tract infections.
• Lower physician and patient tolerance for uncertainty was associated with increased antibiotic use for acute tonsillitis.
• Higher diagnostic uncertainty led to less antibiotic use for pneumonia.

Conclusions:

• Diagnostic uncertainty significantly influences antibiotic prescribing behavior in primary care.
• Strategies to reduce diagnostic uncertainty and improve uncertainty management can curb antibiotic overuse.
• Targeting physician and patient tolerance of uncertainty may enhance antibiotic stewardship.