OBJECTIVES: To determine the clinical attitudes and behaviour of family doctors in Hong Kong towards patient self-management of upper respiratory tract infections, and factors which may influence this practice. DESIGN: Questionnaire survey conducted between February 1999 and April 1999. SETTING: Hong Kong College of Family Physicians. PARTICIPANTS: Members of the Hong Kong College of Family Physicians. RESULTS: A total of 730 family doctors completed a postal questionnaire on self-management of upper respiratory tract infection, giving an overall response rate of 71.9%. The majority (95.2%) of respondents agreed that patients should be advised on self-management. More than two thirds (69.7%) of respondents also considered patients should be advised on self-medications for upper respiratory tract infection. Nearly two thirds and one third of respondents stated they would advise more than 60% of patients on self-management and self-medication, respectively. A close association was noted between the doctor's view on the usefulness of antibiotics for upper respiratory tract infection and patient advice regarding self-management and self-medication strategies. CONCLUSION: Doctors with certain characteristics are more likely to advise patients with upper respiratory tract infection on self-management and self-medication for upper respiratory tract infection.published_or_final_versio

Lam, KF

Lam, TP

Hong Kong Medical Journal

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Title Family doctors' attitudes towards patient self-management ofupper respiratory tract infections.Author(s) Lam, TP; Lam, KFCitation Hong Kong Medical Journal = Xianggang Yi Xue Za Zhi / HongKong Academy Of Medicine, 2001, v. 7 n. 2, p. 146-149Issued Date 2001URL http://hdl.handle.net/10722/45118Rights Creative Commons: Attribution 3.0 Hong Kong License146      HKMJ Vol 7 No 2 June 2001ORIGINAL ARTICLEKey words:Family medicine;General practice;Management pattern;Respiratory tract infectionFamily doctors’ attitudes towardspatient self-management of upperrespiratory tract infectionsObjectives. To determine the clinical attitudes and behaviour of familydoctors in Hong Kong towards patient self-management of upper respiratorytract infections, and factors which may influence this practice.Design. Questionnaire survey conducted between February 1999 and April1999.Setting. Hong Kong College of Family Physicians.Participants. Members of the Hong Kong College of Family Physicians.Results. A total of 730 family doctors completed a postal questionnaireon self-management of upper respiratory tract infection, giving an over-all response rate of 71.9%. The majority (95.2%) of respondents agreedthat patients should be advised on self-management. More than two thirds(69.7%) of respondents also considered patients should be advised onself-medications for upper respiratory tract infection. Nearly two thirdsand one third of respondents stated they would advise more than 60% ofpatients on self-management and self-medication, respectively. A closeassociation was noted between the doctor’s view on the usefulness ofantibiotics for upper respiratory tract infection and patient advice regardingself-management and self-medication strategies.Conclusion. Doctors with certain characteristics are more likely to advisepatients with upper respiratory tract infection on self-management andself-medication for upper respiratory tract infection.&'*&'* 1999 2 1999 4&'*&'730&'*& 71.9% (95.2%)&'&'(69.7%)&'*&' 2/3 1/3&' 60%&'*&'*'&'*○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○TP Lam KF Lam HKMJ 2001;7:146-9&'*The University of Hong Kong:Family Medicine Unit, Department ofMedicineTP Lam, MFM (Monash), FRACGPDepartment of Statistics and ActuarialScienceKF Lam, PhDCorrespondence to: Dr TP LamIntroductionUpper respiratory tract infections (URTIs) are by far the most commondiagnosis made in general family practice in Hong Kong, accounting forHKMJ Vol 7 No 2 June 2001      147Upper respiratory tract infection34.6% of all diagnoses, according to a morbidity sur-vey conducted by the Hong Kong College of FamilyPhysicians.1 Upper respiratory tract infection is also acommon diagnosis worldwide and is responsible for asignificant proportion of primary care consultations.2,3Many patients may attend their family doctor becausethey believe antibiotics are useful for URTIs. Thereis however, an increasing realisation that for mostacute respiratory illnesses—common cold, sore throat,otitis media, sinusitis, and bronchitis—treatment withantibiotics is likely to be of only marginal benefit toindividual patients.4-6 Despite this, 12 million anti-biotic prescriptions were written for colds, URTIs, andbronchitis during 1992 in the US alone. This equatesto approximately 21% of all antibiotic prescriptionsfor adults in the US in that year.7Antibiotic prescribing for URTIs has been shownto have multiple consequences, including higher con-sultation rates,8 increased re-attendance rates,9 and theemergence of drug-resistant bacteria.10-12 Effectivenegotiation, communication and information sharingappears to be crucial when dealing with parents andtheir young children with acute respiratory illness.13Observational studies investigating the quality ofconsultations in family practice, have shown that whenpsychosocial problems are addressed, prescribing ofantibiotics falls.14 The objectives of this study were,therefore, to determine the clinical attitudes andbehaviour of family doctors in Hong Kong towardsself management of URTIs, as well as the factorsinfluencing these attitudes and behaviours.MethodsThis study forms part of a larger research project,investigating the management of URTIs by family doc-tors in Hong Kong.15 All 1016 fellows, members andassociate members of the Hong Kong College ofFamily Physicians normally residing in Hong Kongwere sent an explanatory letter and a questionnaire forcompletion between February 1999 and April 1999. In-formation including age, sex, years of clinical practice,postgraduate qualifications, formal vocational train-ing in family medicine, type of clinical practice (privateversus public), and any special clinical interests,together with clinical attitudes and behaviour withregard to patient self-management of URTI, wasrequested. Each questionnaire comprised two sheets.Data were analysed using Statistical Package forSocial Sciences (Windows version 8.0; SPSS Inc.,Chicago, US) for preliminary summary statistics. Asthe majority of variables were ordinal values, anordinal logistic regression analysis was carried out foreach variable of interest. The statistical significanceof potential explanatory variables—continuousvariables (such as age and years of practice), discretevariables (such as sex, and type of practice) and ordin-al variables (responses to some questions) —weretested by the likelihood ratio test using JMP (Windowsversion 3.2; SAS Institute Inc., Cary, North Carolina,US).ResultsBy early July 1999, 733 questionnaires had beenreturned after three mailings. Three questionnaireswere returned because of incorrect addresses. Thirty-one respondents were asked to complete questionnairesbecause they had overlooked the second page. Theoverall response rate was 71.9% (730/1016). The re-sponse rate was higher among fellows (83.6%) than inmembers (75%) or associate members (63.5%).Respondents included 560 males, 167 females, anda further three respondents who declined to disclosetheir sex. Age of respondents ranged from 24 to 78years (median, 40 years). They had been in clinicalpractice from less than 1 year to 48 years (median, 15years). As expected, the older the respondent, the longerthe years of clinical practice (correlation coefficient,r=0.974, P<0.001). There were more family doctorsworking in the private than the public sector (62.9% ver-sus 37.1%). Ninety percent of respondents had specialclinical interests, including internal medicine (30.0%),paediatrics (16.6%), obstetrics and gynaecology(7.8%), dermatology (5.6%), and surgery (4.0%).The majority of respondents (695/730; 95.2%)indicated that patients should be advised on simpleself-management for URTI, for example, bed rest andoral fluids, whereas 4.5% (33/730) did not agree withthis approach. These responses were related to practi-tioner age (P<0.0001), and years of clinical practice(P<0.0001). Older, and more senior family doctorswere more likely not to advise patients on self-management practices (P<0.0001 for both variables).Most respondents (509/730; 69.7%) also thoughtpatients should be advised on the use of simple self-medications for URTI, such as paracetamol andantihistamines, whereas 29.6% (216/730) did not agreewith such advice. Responses were related to age(P<0.05), years of clinical practice (P<0.05), type ofpractice (P<0.05), special clinical interest (P<0.01) andpostgraduate vocational training in family medicine(P<0.05). Older doctors (P<0.0001), more senior148      HKMJ Vol 7 No 2 June 2001Lam et aldoctors (P<0.0001), those in private practice (P<0.0001),and practitioners with special clinical interests insurgery and surgical specialties (P<0.001) were lesslikely to advise patients on self-management includ-ing simple self-medications. Family doctors with formalpostgraduate vocational training in family medicine,however, were more likely to support self-managementby patients (P<0.01). Furthermore, if a doctor was morelikely to advise patients of simple self-management,he/she was also more likely to advise patients on theuse of simple self-medications (P<0.001).Family doctors were also asked how frequently theywould advise patients on simple self-management forURTIs. Two thirds of doctors responded that they wouldadvise self-management for over 60% of patients withURTI (Table 1). This practice was related to their ageand years of clinical practice, with older, and moresenior doctors less frequently advising patients ofself-management (P<0.001 for both variables).Doctors who thought patients should be advised of self-management (P<0.0001), including self-medications(P<0.0001) however, more frequently advised patientsof these practices. A close relationship was noted withrespect to whether the doctor advised his/her patientson self-management for URTI, and tendency to pre-scribe antibiotics for this condition. The more likely itwas that the doctor prescribed antibiotics for URTI,the less likely it was that he/she would advise his/herpatients on self-management (P<0.05). If the doctorthought antibiotics were useful for URTI (P<0.05),he/she more often prescribed antibiotics (P<0.01);and the more patients the family doctor believed wereexpecting antibiotics (P<0.05), the less frequently he/she would advise on self-medications.Approximately one third of doctors indicatedthat they would advise more than 60% of patientswith URTI on the use of self-medications (Table 2).Doctors in private practice were more likely to advisethe use of self-medications than their public practicecounterparts.DiscussionThis questionnaire survey reveals the approach to man-agement of patients with URTI taken by family doc-tors in Hong Kong. Upper respiratory tract infectionaccounts for a significant proportion of primary careconsultations, consuming important health care re-sources. It is therefore reassuring to note in this regardthat the vast majority of respondents believed pa-tients should be advised of simple self-managementstrategies for their URTI. The data gathered, however,also indicates that only approximately two thirds ofrespondents were regularly advising self-managementfor more than 60% of patients seen with URTI. Thisraises the issue of how the remaining patients withURTI are managed by their family doctors. Are thesepatients given medications that they do not need? Dofamily doctors teach individual patients what theyneed to know about their illnesses?In addition, it is interesting to note that approxi-mately one third of respondents said that they wouldadvise more than 60% of patients with URTI regard-ing the use of self-medications. Doctors in privatepractice appeared more in favour of this approach thandoctors in public practice. This refutes the commonlyheld view that private doctors might be less motivated toeducate patients on health care for fear of losing patients.The negative relationship between the doctor’s viewon the usefulness of antibiotics and their advice onself-management and self-medication highlights theimportance of educating primary care doctors on thisimportant issue. It also confirms the close relationshipbetween inappropriate management and increasedhealth care utilisations.Patients now expect their doctor to provide themwith necessary information on their illness.16 Surveys,such as this study, provide information on how closelythis expectation is currently matched with clinicalreality.Table 2. Responses to the question ‘How often doyou advise patients on simple self-medications (egparacetamol and antihistamines) for their upperrespiratory tract infection?’Frequency (%) Respondents, n=730No. (%)0-19 251 (34.4)20-39 113 (15.5)40-59 130 (17.8)60-79 105 (14.4)80-100 125 (17.1)Missing data 6 (0.8)Table 1. Responses to the question ‘How often do youadvise patients on simple self-management (eg bedrest, oral fluids) for their upper respiratory tractinfection?’Frequency (%) Respondents, n=730No. (%)0–19 79 (10.8)20-39 70 (9.6)40-59 91 (12.5)60-79 113 (15.5)80-100 375 (51.4)Missing data 2 (0.3)HKMJ Vol 7 No 2 June 2001      149Upper respiratory tract infectionConclusionThis study has identified major factors affectingfamily doctor’s advice to patients on self-managementand self-medication for URTIs. These findings areimportant to understand the clinical behaviour ofdoctors in managing the most common condition infamily practice.AcknowledgementThis study was made possible by a grant from theCommittee of Research and Conference Grants ofthe University of Hong Kong. We would also like tothank research assistant Mr K Wong for his valuableassistance with the statistical analysis.References1. Lee A, Chan KK, Wun YT, Ma PL, Li L, Siu PC. A morbiditysurvey in Hong Kong, 1994. HK Pract 1995;17:246-55.2. de Melker RA, Kuyvenhoven MM. Management of upperrespiratory tract infection in Dutch general practice. Br J GenPract 1991;41:504-7.3. Mainous AG 3rd, Hueston WJ, Clark JR. Antibiotics andupper respiratory infection: do some folks think there is a curefor the common cold. J Fam Pract 1996;42:357-61.4. Fahey T. Antibiotics for respiratory tract symptoms in generalpractice. Br J Gen Pract 1998;48:1815-6.5. Orr PH, Scherer K, Macdonald A, Moffatt ME. Randomizedplacebo-controlled trials of antibiotics for acute bronchitis:a critical review of the literature. J Fam Pract 1993;36:507-12.6. Verheij TJ, Hermans J, Mulder JD. Effects of doxycycline inpatients with acute cough and purulent sputum: a double blindplacebo controlled trial. Br J Gen Pract 1994;44:400-4.7. Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing foradults with colds, upper respiratory tract infections, and bron-chitis by ambulatory care physicians. JAMA 1997;278:901-4.8. Howie JG, Hutchison KR. Antibiotics and respiratory illnessin general practice: prescribing policy and work load. BMJ1978;2:1342.9. Little P, Gould C, Williamson I, Warner G, Gantley M,Kinmonth AL. Reattendance and complications in a random-ised trial of prescribing strategies for sore throat: the medicalis-ing effect of prescribing antibiotics. BMJ 1997;315:350-2.10. Drug-resistant Streptococcus pneumoniae—Kentucky andTennessee, 1993. MMWR Morb Mortal Wkly Rep 1994;43:23-6, 31.11. Cherian T, Steinhoff MC, Harrison LH, Rohn D, McDougalLK, Dick J. A cluster of invasive pneumococcal disease inyoung children in child care. JAMA 1994;271:695-7.12. Henderson FW, Gilligan PH, Wait K, Goff DA. Nasopharyn-geal carriage of antibiotic-resistant pneumococci by childrenin group day care. J Infect Dis 1988;157:256-63.13. Kai J. Parents’ difficulties and information needs in copingwith acute illness in preschool children: a qualitative study.BMJ 1996;313:987-90.14. Howie JG, Porter AM, Forbes JF. Quality and the use of timein general practice: widening the discussion. BMJ 1989;298:1008-10.15. Lam TP, Lam KF. Management of upper respiratory tractinfection by family doctors. IJCP. In press.16. Chan CS. What do patients expect from consultations forupper respiratory tract infections? Fam Pract 1996;13:229-35.

Family doctors' attitudes towards patient self-management of upper respiratory tract infections.

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Family doctors' attitudes towards patient self-management of upper respiratory tract infections.

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