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GPs feel pressurised to prescribe unnecessary antibiotics, survey finds

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5238 (Published 20 August 2014) Cite this as: BMJ 2014;349:g5238
  1. Andrew Cole
  1. 1London

Many GPs feel under pressure to prescribe antibiotics even when they may not be the correct treatment, and some patients continue to expect antibiotics as a matter of right, two parallel surveys from the Longitude Prize charity have found.

The surveys of more than 1000 GPs and a similar number of patients were commissioned by Nesta, the organisation behind the £10m (€12.5m; $16.6m) Longitude Prize, which the public voted to award to finding smarter ways of using existing antibiotics, in the face of growing resistance and a dearth of new types.1

The survey of GPs found that 55% felt under pressure—mainly from patients—to prescribe antibiotics, even if they were not sure that they were necessary, and 44% admitted that they had prescribed antibiotics to get a patient to leave the surgery. A similar proportion (45%) had prescribed antibiotics for a viral infection, knowing that they would not be effective. GPs who qualified before 1980 were most likely to have done this (55%). Over a quarter of GPs (28%) admitted prescribing antibiotics “several times a week,” even when not sure of their medical necessity. Over two thirds (70%) said that they did so because they did not know whether an infection was viral or bacterial, and a quarter (24%) said that this was because of a lack of easy to use diagnostic tools.

The parallel survey of patients showed that one in 10 people who visited their surgery at least once a month expected to be prescribed antibiotics every time, and another 13% expected them most of the time. Overall, around 4% of adults expected to have antibiotics prescribed every time they visited their GP and 6% on most occasions. Employment status and age had an effect on expectation levels. People who worked full time were more likely to expect antibiotic treatment every time (6%) compared with those who were not in work (1%). And although 13% of 18-24 year olds expected antibiotics most of the time, just 2% of those aged over 65 did so.

Nearly nine in 10 patients (88%) said that their main reason for requesting antibiotics was to get rid of an infection, 13% for a persistent cold or flu, 9% for an unidentifiable pain, and 9% for a child who was ill. Men were more likely than women to request antibiotics for colds or flu (16% v 9%).

Three per cent of respondents said that they stocked up on antibiotics for future use, one in 10 had used old antibiotics that they had at home, and 7% had used antibiotics that had been prescribed to family or friends. One in 20 had gone to a walk-in centre after failing to get antibiotics from a GP, and this figure was higher among 18-24 year olds (14%) and Londoners (9%).

Nearly two thirds of the patients correctly stated that antibiotics should be used against bacterial infections, but 9% thought that they should be used to treat viral infections, and 27% thought that they dealt with both types of infection. Women were more likely than men to understand that antibiotics were for bacterial infections (74% v 54%), while only 57% of people who regularly visited their surgery understood this.

Notes

Cite this as: BMJ 2014;349:g5238

References

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