From Visiting a Physician to Expecting Antibiotics: Korean Perspectives and Practices Toward Respiratory Tract Infections

ORIGINAL ARTICLE Respiratory Diseases https://doi.org/10.3346/jkms.2017.32.2.278 • J Korean Med Sci 2017; 32: 278-286 From Visiting a Physician to Expecting Antibiotics: Korean Perspectives and Practices toward Respiratory Tract Infections Leila Freidoony,1,2 Chun-Bae Kim,1,2,4 Antibiotic resistance is steadily rising worldwide. Respiratory tract infections (RTIs) are Hamid Haghani,3 Myung-Bae Park,1,2 common indications, mostly imprudent, for antibiotic prescriptions in outpatient setting. Sei-Jin Chang,1,4 Sang-Ha Kim,5 In Korea, antibiotic prescription rate for RTIs is still high. As physician visit and antibiotic and Sang Baek Koh1,4 prescribing are influenced by patient’s perceptions and beliefs, we aimed to explore the general public’s perspectives and practices toward RTIs and to develop the ‘RTI clinical 1Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, iceberg.’ A cross-sectional survey was conducted in Wonju Severance Christian Hospital Korea; 2Institute for Poverty Alleviation and (WSCH) among 550 adults attending outpatient departments during January 2016. International Development, Yonsei University, Differences in distributions between groups were examined using two-tailed Pearson χ2 3 Wonju, Korea; Department of Biostatistics, School test. Using the Andersen’s behavioral model as a conceptual framework, we constructed of Public Health, Iran University of Medical Sciences, Tehran, Iran; 4Institute of Occupation and logistic regression models to assess factors associated with physician visit. Of 547 Environmental Medicine, Yonsei University Wonju participants with complete questionnaires, 62.9% reported having experienced an RTI in College of Medicine, Wonju, Korea; 5Department of the previous six months; 59.3% visited a physician for the illness, most commonly because Internal Medicine, Yonsei University Wonju College the symptoms were severe or prolonged, and approximately 16% of them expected an of Medicine, Wonju, Korea antibiotic prescription from the visit. Perceptions of symptoms severity, the need factor, Received: 28 June 2016 most strongly influenced physician visit. Predisposing and enabling factors such as Accepted: 16 October 2016 inappropriate expectations for antibiotic for a sore throat or having national health insurance also influenced physician visit. Almost all participants who reported asking for an Address for Correspondence: Chun-Bae Kim, MD, PhD antibiotic were prescribed one, with a 37.1% non-adherence rate. Conclusively, public Department of Preventive Medicine, Yonsei University Wonju education on self-care for RTI symptoms that addresses their main concerns may reduce College of Medicine, 20 Ilsan-ro, Wonju 26426, Republic of Korea physician visits. Improving physician-patient relationship and informing patients about the E-mail: [email protected] lack of antibiotic benefit for most RTIs may also reduce antibiotic prescriptions. Funding: This work was supported by the Ministry of Education of the Republic of Korea and the National Research Foundation Keywords: Antibiotics; Respiratory Tract Infections; Expectations; Physician Visit; of Korea (NRF-2016S1A5B8925203); and 2015 Korean Community Health Survey, funded by the Korea Centers for Attitudes; Practices; Adherence; South Korea Disease Control and Prevention, Gangwon province and 7 Districts (Hoengseong, Hongcheon, Jeongseon, Pyeongchang, Taebaek, Wonju, and Yeongwol) in Korea. INTRODUCTION implemented to promote the prudent use of antibiotics, particularly for acute RTIs. These policies include separation of pre- Antibiotic resistance is a serious global concern with steady rise scribing from dispensing, public educational campaigns, and that has reduced the effectiveness of current treatments for com- public disclosure of physicians’ antibiotic prescriptions (11-13). mon infectious diseases (1). While overuse of antibiotics accel- Despite a significant decrease in the past decade, the antibiotic erates the emergence of resistance, prudent lower use slows prescription rate in Korea remains higher than the rates in oth- down this trend (2,3). Acute respiratory tract infections (RTIs) er developed countries (14). In addition, there is a steady up- are the most common illnesses experienced worldwide (4), ac- ward trend for total consumption of antibiotics, with significant- counting for numerous visits to physicians and imprudent pre- ly higher rates in outpatient settings (15). Furthermore, despite scriptions of antibiotics (2). As these infections are largely viral public educational campaigns, the general public still has mis- and self-limiting, antibiotics offer little benefit for these condi- conceptions and poor attitudes toward antibiotic efficacy and tions (5,6). Globally, concerted efforts targeting both clinicians use (16). and the public have been implemented in order to reduce the Multifaceted coordinated interventions that facilitate behav- antibiotic prescription rate and expectations for antibiotics in ior change in both patients and clinicians are generally more RTIs (7,8). successful in addressing the problem of imprudent antibiotic In Korea, antibiotic resistance rates are particularly high (9,10). prescriptions (17). However, little is known about the Korean Thus, various and relatively effective health policies have been general public’s expectations for consultations and antibiotics © 2017 The Korean Academy of Medical Sciences. pISSN 1011-8934 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. eISSN 1598-6357 Freidoony L, et al. • Korean Respiratory Tract Infection Clinical Iceberg in RTIs (18). As improved understanding of individual patient’s and the sample size formula for hypothesis testing for two pop- perspective and his/her journey through an RTI illness can help ulation proportions, it was necessary to sample 550 individuals physicians make better shared decisions and develop multifac- in each field for a margin of error of 0.05 at a 95% confidence eted interventions (19), we aimed to develop a description of interval (CI). A 5%–6% expected rate of incomplete response the components of the ‘RTI clinical iceberg’ (20) by exploring was also considered. the practices, expectations, and adherence of the general public toward RTIs and antibiotics. Furthermore, the Andersen’s behavioral model of healthcare utilization (21) was used as the � � �� ̅�� conceptual framework to identify factors associated with inten- �� ̅�� ̅�� Where ��1.96, 1.28α �� for �90%� power, proportion in one population, tion to visit a physician. The modelWhereWhere suggests that healthcare1.96,1.96, uti-1.281.28 for forWhere 90% 90% power, power,z1-��/2 =�� 1.96,� �proportion proportionz1-β = 1.28 in infor one one 90% population, population, power, p 1 = proportion � lization is influenced by three main decision components:�� pre� -� in one�� population,� p2 = proportion �� in the other population, �� proportion �� in the other population, � 1 , 1 , average of � and , average of �� disposing factors (including socio-demographicproportionproportion in in the the other othercharacteristics population, population, q1 1 =1 1-p,1,, q2 = 1 1-1 p2,, , = averageaverage average of of p 1 and and p2,,, = average averageaverage of of q1 � � � � � � � and health/disease knowledge and attitudes), andenabling; the factors minimum effectand q 2size; the ( minimum� � )�� considered effect� � size ��to be(p1 -�significantp̅ 2�) considered was �0.1. to be signifi� ��- � �� ̅ �̅ � �� (including family and communityandand resources,; ;the the minimum minimum accessibility, effect effect size size and ( ( cant) ) considered wasconsidered 0.1. to to be be significant significant was was 0.1. 0.1. �� availability), and need factors as the�� most immediate cause of� �� healthcare use (including perceived/evaluatedSurvey health questionnaire status Survey questionnaire and severity of symptoms). ThisSurveySurvey model questionnaire questionnairemay help better explain The questionnaire was developed mostly from previous studies different health-seeking behaviors. The questionnaire waswith developed similar objectives mostly from (16,20,23), previous studiesso that with face similar and content objectives va- (16,20,23), so TheThe questionnaire questionnaire was was developed developed mostly mostly from from previous previous studies studies with with similar similar objectives objectives (16,20,23), (16,20,23), so so lidity were assured. However, the questions were also assessed that face and content validity were assured. However, the questions were also assessed and slightly MATERIALS AND METHODSthatthat face face and and content content validity validity were were assured. assured.and slightlyHowever, However, rephrased the the questions questions according were were also also to assessedthe assessed study and and objectives slightly slightly by a rephrased according topharmacist the study objectives and a physician by a phar withmacist clinical and a physicianexpertise. with Additional clinical- expertise. rephrasedrephrased according

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