Patient Willingness to Have Tests to Guide Antibiotic Use for Respiratory Tract Infections: From the WWAMI Region Practice and Research Network (WPRN)

Malaika Schwartz; Victoria Hardy; Gina A. Keppel; William Alto; Jaime Hornecker; Beth Robitaille; Jon Neher; John Holmes; M. Ashworth Dirac; Allison M. Cole; Matthew Thompson

doi:10.3122/jabfm.2017.05.170087

Article Figures & Data

Figures

Tables

Download figure
Open in new tab
Figure 1.
Most frequent reasons cited by respondents for deciding to have a fingerstick test to help guide antibiotic use.
Download figure
Open in new tab

Tables

Figures

View popup

Table 1.

Characteristics of Respondents

Age (years) (N = 722), mean ± SD	46.9 ± 17.1
<40	283 (39.2)
40–59	260 (36.0)
≥60	179 (24.8)
Gender (N = 718)^*
Male	246 (34.3)
Female	472 (65.7)
Ethnicity (N = 672)
Non-Hispanic/Latino	578 (86.0)
Hispanic/Latino	94 (14.0)
Race (N = 697)^{^†}
White only	419 (60.1)
Black only	82 (11.8)
American Indian/Alaska Native only	54 (7.7)
Asian/Pacific Islander only	60 (8.6)
Multiple/other race	82 (11.8)
Health status (N = 721)
Poor	187 (25.9)
Average	164 (22.8)
Good	370 (51.3)
Smoking status (N = 726)
Never smoker	377 (51.9)
Former smoker	167 (23.0)
Current smoker	182 (25.1)
Health insurance (N = 723)^{^‡}
No health insurance	75 (10.4)
Private health insurance only	183 (25.3)
Medicaid and/or Medicare only	365 (50.5)
Multiple/other health insurance	100 (23.8)
Survey language (N = 737)
English	705 (95.7)
Spanish	32 (4.3)

Data are n (%) unless otherwise indicated.
↵* One respondent wrote “FTM” (female to male), so they were categorized as male.
↵† Because respondents were allowed to select more than 1 race/ethnicity, we counted 747 responses for 697 subjects.
↵‡ Because respondents were allowed to select more than 1 type of insurance, we counted 852 responses for 723 subjects.

View popup

Table 2.

Experience with Respiratory Tract Infections, Preference for and Knowledge about Antibiotics, and Willingness to Have Blood Tests

No. of doctor visits for a cough/cold in past 12 months (N = 706)
0	467 (66.1)
1	103 (14.6)
≥2	136 (19.3)
No. of times antibiotics were given for cough/cold during doctor visit (N = 231)
0	87 (36.0)
1	86 (35.5)
≥2	69 (28.5)
Preferences for antibiotics (N = 692)
I prefer to take antibiotics for a cough or cold, even if my doctor thinks antibiotics may not help me.	88 (12.7)
I prefer to avoid taking antibiotics, but I will take antibiotics if my doctor thinks they will help my cough or cold.	604 (87.3)
Knowledge of antibiotics (N = 708)^*
Viruses	68 (9.6)
Bacteria^{^†}	268 (37.9)
Viruses and bacteria	178 (25.1)
Don't know	194 (27.4)
Willingness to undergo arm blood draw (N = 700)
Unwilling	153 (21.9)
Neutral	105 (15.0)
Willing	442 (63.1)
Willingness to undergo fingerstick test (N = 677)^{^‡}
Unwilling	102 (15.1)
Neutral	40 (5.9)
Willing	535 (79.0)

Data are n (%).
↵* Antibiotic knowledge was measured by a subject's response to the question, “I understand that antibiotics are best for treating coughs and colds that are caused by (viruses, bacteria, viruses/bacteria, don't know).”
↵† Correct answer.
↵‡ Responses from 60 subjects who did not answer the question about willingness to have a fingerstick test are included in the overall results but not in the analyses of associations with this outcome.

View popup

Table 3.

Associations between Demographics, Health Status and Attitudes, and Willingness to Have Fingerstick Blood Test and Antibiotic Knowledge

	Antibiotic Knowledge		Willingness to Have Fingerstick Blood Test
	Incorrect (N = 440)	Correct (N = 268)	Unwilling/Neutral (N = 142)	Willing (N = 535)
Age, years (N = 702)^*
Mean ± SD	47.5 ± 17.0	45.6 ± 17.1	45.5 ± 18.0	47.2 ± 16.8
<40	154 (35.5)	123 (45.9)	58 (42.0)	206 (39.0)
40–59	169 (38.9)	85 (31.7)	46 (33.3)	193 (36.6)
≥60	111 (25.6)	60 (22.4)	34 (24.6)	129 (24.4)
Gender (N = 698)^*
Male	174 (40.3)	64 (24.1)	52 (38.0)	178 (33.8)
Female	258 (59.7)	202 (75.9)	85 (62.0)	348 (66.2)
Ethnicity (N = 654)^*
Hispanic/Latino	73 (18.3)	17 (6.6)	18 (14.3)	64 (12.9)
Non-Hispanic/Latino	325 (81.7)	239 (93.4)	108 (85.7)	434 (87.1)
Race (N = 679)^{^*^†}
White only	211 (50.7)	199 (75.7)	75 (56.0)	322 (62.9)
Black only	62 (14.9)	17 (6.4)	15 (11.2)	55 (10.7)
American Indian/Alaska Native only	38 (9.1)	14 (5.3)	19 (14.2)	32 (6.3)
Asian/Pacific Islander only	45 (10.8)	12 (4.6)	11 (8.2)	42 (8.2)
Multiple/other race	60 (14.4)	21 (8.0)	14 (10.4)	61 (11.9)
Health insurance (N = 703)^{^*^†}
No health insurance	42 (9.6)	31 (11.6)	13 (9.2)	56 (10.7)
Private health insurance only	83 (19.0)	98 (36.7)	25 (17.7)	148 (28.1)
Medicaid and/or Medicare only	235 (53.9)	119 (44.6)	74 (52.5)	262 (49.8)
Multiple/other health insurance	76 (17.4)	19 (7.1)	29 (20.6)	60 (11.4)
Health status (N = 702)
Poor	118 (27.2)	65 (24.2)	28 (20.1)	140 (26.5)
Average	104 (24.0)	56 (20.9)	37 (26.6)	119 (22.5)
Good	212 (48.8)	147 (54.9)	74 (53.2)	269 (60.0)
Language (N = 708)^*
Spanish	30 (6.8)	1 (0.4)	3 (2.1)	22 (4.1)
English	410 (93.2)	267 (99.6)	139 (97.9)	513 (95.9)
Smoking status (N = 706)
Never smoker	228 (52.0)	137 (51.3)	73 (51.8)	273 (51.7)
Former smoker	97 (22.0)	65 (24.3)	35 (24.8)	120 (22.7)
Current smoker	114 (26.0)	65 (24.3)	33 (23.4)	135 (25.6)
No. of doctor visits for a cough/cold in past 12 months (N = 688)
0	285 (67.2)	170 (64.4)	94 (70.7)	337 (65.2)
1	55 (13.0)	45 (17.0)	18 (13.5)	79 (15.3)
≥2	84 (19.8)	49 (18.6)	21 (15.8)	101 (19.5)
No. of times antibiotics given for cough/cold during doctor visit (N = 226)
0	43 (32.3)	38 (40.9)	12 (30.8)	64 (36.6)
1	45 (33.8)	36 (38.7)	16 (41.0)	63 (36.0)
≥2	45 (33.8)	19 (20.4)	11 (28.2)	48 (27.4)
Preferences for antibiotics (N = 686)^*
Prefer to take antibiotics	70 (16.6)	17 (6.4)	21 (15.6)	60 (11.6)
Prefer to avoid taking antibiotics	352 (83.4)	247 (93.6)	114 (84.4)	456 (88.4)
Knowledge of antibiotics (N = 661)^{^†}
Incorrect	N/A	N/A	99 (71.7)	307 (58.7)
Correct	—	—	39 (28.3)	216 (41.3)
Willingness to undergo arm blood draw (N = 662)^{^†}
Unwilling	101 (23.8)	49 (18.4)	87 (62.6)	53 (10.1)
Neutral	58 (13.6)	47 (17.7)	45 (32.4)	54 (10.3)
Willing	266 (62.6)	170 (63.9)	7 (5.0)	416 (79.5)
Willingness to undergo fingerstick test (N = 661)^*
Unwilling	75 (18.5)	25 (9.8)	N/A	N/A
Neutral	24 (5.9)	14 (5.5)	—	—
Willing	307 (75.6)	216 (84.7)	—	—

Data are n (%) unless otherwise indicated.
↵† Significant at the 0.05 level for willingness to have fingerstick blood test.
↵* Significant at the 0.05 level for antibiotic knowledge.
N/A, not applicable.

View popup

Table 4.

Crude and Adjusted Odds Ratios of Willingness to Have a Fingerstick Test and Antibiotic Knowledge

	Antibiotic Knowledge		Willingness to Have a Fingerstick Test
	Crude (N = 708)	Adjusted^* (N = 632)	Crude (N = 677)	Adjusted^{^†} (N = 652)
Age (years)
<40	Reference	Reference	Reference	Reference
40–59	0.63 (0.44–0.90)^{^‡}	0.70 (0.47–1.05)	1.18 (0.77–1.82)	1.15 (0.63–2.10)
≥60	0.68 (0.46–1.00)	0.59 (0.37–0.94)^{^‡}	1.07 (0.66–1.72)	1.65 (0.82–3.30)
Sex
Male	Reference	Reference	Reference	Reference
Female	2.13 (1.51–2.99)^{^§}	2.20 (1.50–3.22)^{^§}	1.20 (0.81–1.77)	0.86 (0.50–1.50)
Hispanic/Latino	Reference	Reference	Reference	Reference
Non-Hispanic/Latino	1.33 (0.83–2.16)	0.49 (0.27–0.91)^{^‡}	0.89 (0.50–1.56)	0.99 (0.45–2.20)
Race
White only	Reference	Reference	Reference	Reference
Black only	0.29 (0.16–0.51)^{^§}	0.33 (0.18–0.61)^{^§}	0.85 (0.46–1.59)	1.09 (0.44–2.75)
American Indian/Alaska Native only	0.39 (0.21–0.75)^{^‡}	0.47 (0.22–1.00)^{^‡}	0.39 (0.21–0.73)^{^‡}	0.34 (0.13–0.89)^{^‡}
Asian/Pacific Islander only	0.28 (0.15–0.55)^{^§}	0.21 (0.10–0.44)^{^§}	0.89 (0.44–1.81)	0.45 (0.15–1.32)
Multiple/other race	0.37 (0.22–0.63)^{^§}	0.42 (0.23–0.80)^{^‡}	1.02 (0.54–1.91)	1.67 (0.72–3.87)
Health insurance
No health insurance	Reference	Reference	Reference	Reference
Private health insurance only	1.60 (0.92–2.77)	1.47 (0.77–2.81)	1.37 (0.66–2.87)	1.09 (0.41–2.91)
Medicaid and/or Medicare only	0.69 (0.41–1.15)	0.67 (0.36–1.24)	0.82 (0.43–1.58)	0.85 (0.36–2.02)
Multiple/Other health insurance	0.34 (0.17–0.67)^{^‡}	0.46 (0.21–1.03)	0.48 (0.23–1.02)	0.66 (0.24–1.83)
Survey language
Spanish	Reference	Reference	Reference	Reference
English	19.5 (2.65–144.1)^{^‡}	7.14 (0.87–58.76)	1.99 (0.59–6.74)	2.28 (0.41–12.86)
Smoking status
Never smoked	Reference	Reference	Reference	Reference
Former smoker	1.12 (0.76–1.63)	1.03 (0.67–1.60)	0.92 (0.58–1.45)	1.27 (0.66–2.44)
Current smoker	0.95 (0.65–1.38)	1.15 (0.73–1.80)	1.09 (0.69–1.73)	2.48 (1.32–4.64)^{^‡}
No. of doctor visits for a cough/cold in past 12 months
0	Reference	Reference	Reference	Reference
1	1.37 (0.89–2.12)	1.21 (0.73–2.02)	1.22 (0.70–2.15)	0.81 (0.37–1.79)
≥2	0.98 (0.66–1.46)	1.05 (0.65–1.69)	1.34 (0.80–2.26)	0.80 (0.38–1.65)
No. of times antibiotics given for cough/cold during doctor visit
0	Reference	Reference	Reference	Reference
1	0.91 (0.49–1.68)	1.05 (0.48–2.33)	0.74 (0.32–1.69)	0.48 (0.14–1.64)
≥2	0.48 (0.24–0.95)	0.52 (0.21–1.29)	0.82 (0.33–2.01)	0.71 (0.21–2.45)
Preferences for antibiotics
Prefer to take antibiotics	Reference	Reference	Reference	Reference
Prefer not to take antibiotics	2.88 (1.66–5.03)^{^§}	3.07 (1.61–5.84)^{^‡}	1.40 (0.82–2.40)	1.69 (0.77–3.74)
Knowledge of antibiotics
Incorrect	N/A	N/A	Reference	Reference
Correct	—	—	1.79 (1.19–2.69)^{^‡}	2.80 (1.63–4.85)^{^§}
Willingness to undergo arm blood test
Unwilling	Reference	Reference	Reference	Reference
Neutral	1.67 (1.00–2.79)	1.65 (0.91–3.00)	1.97 (1.17–3.32)^{^‡}	1.87 (1.07–3.26)^{^‡}
Willing	1.32 (0.89–1.95)	1.19 (0.75–1.87)	97.55 (42.91–221.80)^{^§}	142.77 (57.65–353.60)^{^§}
Willingness to undergo fingerstick test
Unwilling	Reference	Reference	N/A	N/A
Neutral	1.75 (0.79–3.89)	1.75 (0.69–4.41)	—	—
Willing	2.11 (1.30–3.43)^{^‡}	1.97 (1.13–3.44)^{^‡}	—	—

Data are odds ratios (95% confidence intervals).
↵* Adjusted for age, sex, race (American Indian/Alaska Native, white), ethnicity, preference for antibiotics, and type of health insurance (private).
↵† Adjusted for race (American Indian/Alaska Native), smoking status (current smoker), knowledge of antibiotics, and willingness to undergo arm blood test.
↵‡ Significant at the 0.05 level.
↵§ Significant at the 0.001 level.
N/A, not applicable.