Information leaflets for patients reduce antibiotic prescriptions and their use should be encouraged. This is the main conclusion of a systematic review in BMJ Open. Below is the citation, abstract and selected extract.

The authors used ‘a broad search strategy for a complete and inclusive search’, and yet they found not a single eligible study from a low-income or middle-income country.

CITATION: Patient information leaflets to reduce antibiotic use and reconsultation rates in general practice: a systematic review

Eefje G P M de Bont, Marleen Alink, Famke C J Falkenberg, Geert-Jan Dinant, Jochen W L Cals

Corresponding author: Eefje G P M de Bont – eefje.debont@maastrichtuniversity.nl

BMJ Open 2015;5:e007612 doi:10.1136/bmjopen-2015-007612

http://bmjopen.bmj.com/content/5/6/e007612.full

Published 3 June 2015

ABSTRACT

Objective: Patients’ knowledge and expectations may influence prescription of antibiotics. Therefore, providing evidence-based information on cause of symptoms, self-management and treatment is essential. However, providing information during consultations is challenging. Patient information leaflets could facilitate consultations by increasing patients’ knowledge, decrease unnecessary prescribing of antibiotics and decrease reconsultations for similar illnesses. Our objective was to systematically review effectiveness of information leaflets used for informing patients about common infections during consultations in general practice.

Design, setting and participants: We systematically searched PubMed/MEDLINE and EMBASE for studies evaluating information leaflets on common infections in general practice. Two reviewers extracted data and assessed article quality.

Primary and secondary outcome measures: Antibiotic use and reconsultation rates.

Results: Of 2512 unique records, eight studies were eligible (7 randomised, controlled trials, 1 non-randomised study) accounting for 3407 patients. Study quality varied from reasonable to good. Five studies investigated effects of leaflets during consultations for respiratory tract infections; one concerned conjunctivitis, one urinary tract infections and one gastroenteritis and tonsillitis. Three of four studies presented data on antibiotic use and showed significant reductions of prescriptions in leaflet groups with a relative risk (RR) varying from 0.53 (0.40 to 0.69) to 0.96 (0.83 to 1.11). Effects on reconsultation varied widely. One large study showed lower reconsultation rates (RR 0.70 (0.53 to 0.91), two studies showed no effect, and one study showed increased reconsultation rates (RR 1.53 (1.03 to 2.27)). Studies were too heterogenic to perform a meta-analysis.

Conclusions: Patient information leaflets during general practitioners consultations for common infections are promising tools to reduce antibiotic prescriptions. Results on reconsultation rates for similar symptoms vary, with a tendency toward fewer reconsultations when patients are provided with a leaflet. Use of information leaflets in cases of common infections should be encouraged. Their contributing role in multifaceted interventions targeting management of common infections in primary care needs to further exploration.

SELECTED EXTRACTS (selected by Neil PW)

When asked, most patients appreciate written information10 and indicate they would be less likely to consult if they had more information about managing minor illnesses.11 ,12 In addition, the use of written information may improve information retention up to 50% and patient satisfaction may improve.13 ,14 Patients presenting with a common infection value information on self-management strategies and expected duration of illness. The use of information leaflets to assist a consultation may be a useful tool to convey information, increase patient knowledge and possibly restrict antibiotic prescriptions.

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Best wishes, Neil

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