A recently published study reveals that as clinicians improperly prescribe antibiotics for viral infections, patients are more likely to seek to use them down the line.
The analysis, which was published online August 10 in the journal, “Clinical Infectious Diseases,” also found that spouses had an increased likelihood of seeking out the antimicrobial substance for a viral acute respiratory infection (ARI).
According to the Nov. 9 announcement of the Harvard Medical School and the Harvard T.H. Chan School of Public Health study, researchers said the results are surprising “because they suggest that once such prescriptions are given improperly for a viral infection they could become a gateway to more antibiotic use.”
“The choices physicians make about prescribing antibiotics can have long-term effects on when individual patients choose to obtain care,” lead study author Zhuo Shi, an HMS student in the Harvard-MIT Program in Health Sciences and Technology program said in a statement. “A physician who prescribes an antibiotic inappropriately needs to understand that it’s not just one little prescription of a harmless antibiotic but a potential gateway to a much bigger problem.”
Using encounter data from a national insurer, researchers analyzed over 200,000 initial visits for acute respiratory infections at 736 urgent care centers in the nation. Researchers discovered that antibiotic prescribing rates for ARIs varied greatly among clinicians at the clinics.
The highest quartile of prescribers saw 80% of clinicians prescribing antibiotics for viral respiratory infections, while 42% did so in the lowest quartile. A year after the urgent care visit, patients in the highest-prescribing clinician group got 14.6% more antibiotics for ARI compared with patients in the lowest-antibiotic-prescribing clinician group.
“You’ll hear lots of people say, ‘Every winter I need antibiotics for bronchitis,’” said senior author Ateev Mehrotra, an associate professor of health care policy in the Blavatnik Institute at Harvard Medical School and a hospitalist at Beth Israel Deaconess Medical Center. “The antibiotics don’t actually help, but patients tend to perceive a benefit. The fancy term for this psychological phenomenon is ‘illusionary correlation.’”
“They get antibiotics and they feel better, not because the antibiotics have worked but because the infection has run its course,” Mehrotra added. “The next time they become ill with similar symptoms they go back to the doctor to get another prescription.”
A 2016 report from the Centers for Disease Control found that 1 in 3 prescriptions are unnecessary. In an analysis of doctor’s office and emergency room visits in the U.S., the CDC found the majority of unnecessary antibiotics were prescribed for respiratory conditions caused by viruses such as sinus and ear infections and the common cold.
According to Kaiser Pemanente, antibiotics cannot kill viruses and won’t treat viral infections.
For more information on the Harvard Medical School study, including the impact of clinicians being randomly assigned to patients visiting urgent care, read the announcement here.
