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Does diagnostic uncertainty increase antibiotic prescribing in primary care?

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journal contribution
posted on 12.04.2021, 22:18 authored by Dan Wang, Chaojie LiuChaojie Liu, Xinping Zhang, Chenxi Liu
AbstractThis study aimed to determine the association between factors relevant to diagnostic uncertainty and physicians’ antibiotic-prescribing behaviour in primary care. A questionnaire survey was conducted on 327 physicians that measured their diagnostic ability, perceived frequency of diagnostic uncertainty, tolerance, and perceived patient tolerance of uncertainty. Physician antibiotic-prescribing behaviours were assessed based on their prescriptions (n = 207,804) of three conditions: upper respiratory tract infections (URTIs, antibiotics not recommended), acute tonsillitis (cautious use of antibiotics), and pneumonia (antibiotics recommended). A two-level logistic regression model determined the association between diagnostic uncertainty factors and physician antibiotic prescribing. Physicians perceived a higher frequency of diagnostic uncertainty resulting in higher antibiotic use for URTIs and less antibiotic use for pneumonia. Higher antibiotic use for acute tonsillitis was related to a low tolerance of uncertainty of physicians and patients. This study suggests that reducing diagnostic uncertainty and improving physician and patient uncertainty management could reduce antibiotic use.


The authors sincerely appreciate the help from the surveyed physicians, investigators, the included primary care facilities, and local governments. This study was funded by the National Natural Science Foundation of China (grant nos. 71373092 and 71904053). The funding body played no part in the study design, collection, analysis and interpretation of data, writing of the manuscript, or the decision to submit the manuscript for publication.


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npj Primary Care Respiratory Medicine





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Springer Nature



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