Understanding local challenges

In the USA and much of Europe, around 60% of patients who go to see their doctor with a sore throat will leave with a prescription for antibiotics, despite the fact that it has been known for a long time that antibiotics are generally ineffective for sore throats, said Dr Martin Duerden, Clinical Adviser on prescribing to the UK Royal College of General Practitioners and Honorary Senior Research Fellow at Bangor University, UK.

To put the problem in context, a Cochrane review showed that 21 patients would need to be treated with an antibiotic for one patient to get some small benefit. The same Cochrane review estimated that it would take 4,000 courses of antibiotics to prevent one serious health complication, said Dr Duerden, whereas there is a lot of evidence that shows many symptomatic treatments are efficient and effective methods to help ease the pain of sore throat.

Sociological research shows that when the doctor-patient relationship is examined, people are rarely asked what they wanted to get from visiting their doctor, nor what they think of their antibiotic treatment. This research has shown that patients want more information than “it’s just a virus”, creating a mismatch between what the healthcare professional thinks the patient is after, and what the patient truly wants. Dr Duerden explained that we need to build a system that helps overcome this mismatch. Part of this comes from the physician asking some simple questions such as, “How can I help you? What is it that you think I should be able to give you? What are your expectations?” It is clear that patients are better satisfied if they are assessed carefully and given a good explanation.

The way to overcome this is to train and educate both the healthcare professional and the patient. This is particularly important in order to overcome some common misconceptions that exist particularly around how long symptoms last. If both the healthcare professional and the patient believe that the symptoms should be over more quickly than they actually are, it is easy to see why patients may get anxious about why they have persisted.

However, Dr Duerden cautioned that alongside this advice, it is important to recognise that there will be some patients who could potentially come to harm and that there are patients at increased risk of complications such as elderly patients or very young children. Therefore it is important for physicians to be very clear what the red flag symptoms might be and how to use the appropriate scoring system to ensure that patients are recommended the correct course of treatment.

Reflecting on how to best implement behaviour change in patients, Dr Duerden emphasised a key opportunity is to work with patients at a very young age to help children understand that antibiotics are only used when they are absolutely necessary. If this can be done successfully, this will pave the way towards changing the perceptions that patients have on how RTI symptoms should be treated.