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Am Fam Physician. 2006;73(8):1450

Clinical Question: Will referring to acute bronchitis as a “chest cold” improve patient satisfaction and reduce inappropriate antibiotic use?

Setting: Outpatient (primary care)

Study Design: Descriptive

Synopsis: Overuse of antibiotics for acute respiratory infection is often a direct result of the pressure of patients’ expectations on their family physician. The investigators developed a written scenario representing a typical acute respiratory illness that might be called bronchitis but does not require antibiotic therapy. Patients presenting to the office for routine appointments for something other than an acute respiratory infection received the scenario and a list of questions evaluating their satisfaction with the diagnosis and treatment.

Three different diagnostic labels: chest cold, viral upper respiratory infection, and bronchitis correlated with a specific treatment program that excluded antibiotic treatment. Of 466 surveys offered, 459 were completed and underwent analysis. The average age of respondents was 43 years; 66 percent were women.

Satisfaction with the diagnosis remained similar with any of the three diagnostic labels; however, patients with the bronchitis label reported significantly more dissatisfaction with not receiving an antibiotic (26 percent) than those given the label of chest cold or viral upper respiratory infection (13 and 17 percent, respectively).

Bottom Line: The use of the label chest cold or viral upper respiratory infection instead of acute bronchitis does not appear to affect patients’ satisfaction with the diagnosis but may improve satisfaction with not receiving an antibiotic. Prospective trials are needed to confirm whether this approach will reduce inappropriate antibiotic use. (Level of Evidence: 2b)

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

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Copyright © 2006 by the American Academy of Family Physicians.

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