Determinants of initiation, implementation, and discontinuation of amoxicillin by adults with acute cough in primary care
Received 8 August 2016
Accepted for publication 9 November 2016
Published 15 March 2017 Volume 2017:11 Pages 561—569
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Akshita Wason
Peer reviewer comments 2
Editor who approved publication: Dr Johnny Chen
David Gillespie,1 Daniel Farewell,2 Lucy Brookes-Howell,1 Christopher C Butler,3 Samuel Coenen,4–6 Nick A Francis,2 Paul Little,7 Beth Stuart,7 Theo Verheij,8 Kerenza Hood1
On behalf of the GRACE consortium
1Centre for Trials Research, College of Biomedical & Life Sciences, 2Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, 3Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK; 4Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), 5Centre for General Practice, Department of Primary and Interdisciplinary Care (ELIZA), 6Clinical Epidemiology and Medical Statistics, Department of Epidemiology and Social Medicine (ESOC), University of Antwerp, Antwerp, Belgium; 7Aldermoor Health Centre, Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; 8Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
Aim: To investigate the determinants of adherence to amoxicillin in patients with acute lower respiratory tract infection.
Materials and methods: Three European data sets were used. Adherence data were collected using self-reported diaries. Candidate determinants included factors relating to patient, condition, therapy, health care system/provider, and the study in which the patient participated. Logistic and Cox regression models were used to investigate the determinants of initiation, implementation, and discontinuation of amoxicillin.
Results: Although initiation differed across samples, implementation and discontinuation were similar. Determinants of initiation were days waited before consulting, duration of prescription, and being in a country where a doctor-issued sick certificate is required for being off work for <7 days. Implementation was higher for older participants or those with abnormal auscultation. Implementation was lower for those prescribed longer courses of amoxicillin (≥8 days). Time from initiation to discontinuation was longer for longer prescriptions and shorter for those from countries where single-handed practices were widespread.
Conclusion: Nonadherence to amoxicillin was largely driven by noninitiation. Differing sets of determinants were found for initiation, implementation, and discontinuation. There is a need to further understand the reasons for these determinants, the impact of poor adherence to antibiotics on outcomes, and to develop interventions to improve antibiotic use when prescribed.
Keywords: adherence, antibiotics, general practice, determinants
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