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

Gillespie, David, Farewell, Daniel, Brookes-Howell, Lucy, Butler, Christopher, Coenen, Samuel, Francis, Nicholas Andrew, Little, Paul, Stuart, Beth, Verheij, Theo and Hood, Kerenza 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:	26 Oct 2019 22:53
URI:	https://orca.cardiff.ac.uk/id/eprint/101095

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