'In Texas, everybody wants antibiotics': reducing inappropriate antibiotic expectations and use with a...

Patients often expect antibiotics for self-limiting diseases, pressuring providers to prescribe antibiotics unnecessarily. These expectations also contribute to the unsafe practice of taking antibiotics without a prescription (non-prescription use), such as pills retained from prior prescriptions or antibiotics from non-medical sources. Previous work shows that non-prescription use is due to strong, widely held misconceptions regarding the curative power of antibiotics. To reduce unnecessary use of antibiotics, we developed and pilot-tested a patient-focused, bilingual (English and Spanish) educational tool with patient and provider stakeholder input. The tool, a trifold brochure, included information on safe antibiotic use, potential antibiotic harms and symptom management with over-the-counter medications.

Using a qualitative design, we conducted a two-phase study to (1) develop a provider-patient communication tool and (2) pilot-test the tool in primary care clinics. Development of the tool involved patient advisory board meetings and healthcare professional (HCP) focus groups. Pilot-testing of the tool was done through semistructured interviews of randomly recruited patients from primary clinic waiting rooms and their providers.

Publicly funded safety net primary care clinics in Texas.

Patients (n=18) and HCPs (nurses, medical assistants, pharmacists, nurse practitioners and physicians) (n=14) from participating clinics.

Themes were extracted from the qualitative data. Main themes from the development phase highlighted the need to create a simple tool to make it clear that antibiotics are not used to treat viral infections, pain or allergies and that using antibiotics without consulting a medical professional is not safe. During pilot-testing, providers noted the tool helped adjust patients' antibiotic expectations. Providers felt that the tool gave them credibility in scenarios where antibiotics were not indicated. Patients felt that the tool provided alternatives to antibiotics for symptom relief. Patients and providers found the tool useful in supporting patient-provider communication around antibiotic use.

A stakeholder-driven, patient-focused educational tool addressing inappropriate antibiotic use facilitated patient-provider communication around antibiotic usage and helped manage patients' antibiotic expectations. Embedding this tool into a community-facing intervention may reduce use of antibiotics without a prescription.