Antibiotic stewardship with upper respiratory tract infection patients at student health centers: Providers’ communication experiences and strategies

Background: Effective provider-patient communication can improve antibiotic stewardship in primary care, but providers find it challenging to discuss antibiotics with patients. This study, focused on college student health centers, examines patients’ tactics for obtaining antibiotics for upper respiratory tract infections and providers’ communication strategies for improving patient understanding and reducing demand. Methods: Health care providers (N = 103) employed at student health centers on large and primarily residential college campuses in the U.S. completed an online survey. Results: Providers perceived patients as wanting antibiotics in approximately 50% of upper respiratory tract infection visits and noted multiple patient tactics to obtain them, including reports of prior prescribing, suggested diagnoses, and direct requests. Providers used multiple strategies to manage patient demand, including explanation of the diagnosis, antibiotic utility and risks, and treatment plan. Discussion: This study extends prior research indicating that patients exercise a range of influence tactics to obtain antibiotics, and thereby create discomfort for providers. The study also elucidates providers’ efforts to counter these influence tactics and steward antibiotics by educating patients. Conclusions: Additional research is needed to specify the most effective ways for providers to respond to patients’ influence tactics, including the best approaches to explaining diagnosis, treatment, and antibiotic resistance.