Determinants of initiation, implementation, and discontinuation of amoxicillin by adults with acute cough in primary care

Gillespie, David ORCID: https://orcid.org/0000-0002-6934-2928, Farewell, Daniel ORCID: https://orcid.org/0000-0002-8871-1653, Brookes-Howell, Lucy ORCID: https://orcid.org/0000-0002-8263-7130, Butler, Christopher, Coenen, Samuel, Francis, Nicholas Andrew ORCID: https://orcid.org/0000-0001-8939-7312, Little, Paul, Stuart, Beth, Verheij, Theo and Hood, Kerenza ORCID: https://orcid.org/0000-0002-5268-8631 2017. Determinants of initiation, implementation, and discontinuation of amoxicillin by adults with acute cough in primary care. Patient Preference and Adherence 2017 (11) , pp. 561-569. 10.2147/PPA.S119256

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Abstract

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.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Subjects:	R Medicine > RM Therapeutics. Pharmacology
Uncontrolled Keywords:	adherence, antibiotics, general practice, determinants
Publisher:	Dove Medical Press
ISSN:	1177-889X
Funders:	ESF
Date of First Compliant Deposit:	2 June 2017
Date of Acceptance:	9 November 2016
Last Modified:	04 May 2023 07:45
URI:	https://orca.cardiff.ac.uk/id/eprint/101095

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