Family Medicine Office Research Articles

Gender Differences in Verbal Behavior Style in Interviews in Family Medicine: Mars and Venus, or North Dakota and South Dakota?

Objective: To describe and compare the doctor-patient communication referred to the verbal behavior of the female patients vs. males in the family medicine consultation. Participants and Methods: Secondary analysis of existing dataset coded to explore patient-clinician verbal communication during ambulatory visits in a family medicine office in a health Centre in Toledo (Spain) was carried out. The audio recording of the consultations and verbal content analysis of the interviews, based on the identification of 6 categories of classification of behaviors of the interaction process (Proposing, Supporting/ Agreeing, Disagreeing, Giving Information, Seeking Information, and Building) was performed. A convenience sample was carried out. Other variables included were age, sex and duration of the consultation in minutes. Triangulation between different evaluators, and methodological (qualitative and quantitative) was used as a technique to control the reliability and biases. Once the qualitative study is completed, the results of the number of behaviors in the total of triadic and dyadic consultations were presented in a quantitative way (Frequencies: No, %). The bivariate comparisons were performed using the test of Chi squared and exact probability Fischer. Results: 20 consultations were included in the analysis. In interviews with women vs. males, differed only in showing more Supporting (39% and 29%, respectively; p=0.05), and less “Disagreement” (3% and 11% respectively; p<0.05). There were no differences in the verbal behaviors of the physician in the consultations with female vs. male patients. There were also no differences in the duration of the consultation among female patients vs. males (7’: rank: 3’-15’ vs. 7’; rank: 4’-12’). Conclusion: The verbal behavior in interview in the family medicine consultation with female patients vs. males shows only small differences. Neither men are of Mars nor the women of Venus; may be men are from North Dakota and women from South Dakota.

Differences in Verbal Behaviour Style in Interviews of Patients Females with Patients Companion (Triads) and Without Patient's Companion (Dyads) in Family Medicine

Objective: To describe differences in verbal behaviour style in interviews of patients females with patient's companion (triadic consultations) and patient’s females without patient's companion (dyadic consultations) in family medicine. Participants and Methods: Secondary analysis of existing dataset coded to explore patient-clinician verbal communication during ambulatory visits in a family medicine office in a health Centre in Toledo (Spain) was carried out. A qualitative study was performed by audio recording of the consultations and verbal content analysis of the interviews, based on the identification of 6 categories of classification of behaviours of the interaction process (Proposing, Supporting/Agreeing, Disagreeing, Giving Information, Seeking Information, and Building). A convenience sample was carried out. A suitable sample number was considered when saturation occurred. Quantitative methodology was used as a technique to control the reliability and biases. Results: 5 unaccompanied consultations and 7 consultations with companion were included in the analysis. The female patients with a companion show 2/3 more verbal behaviours (165 vs. 101) with slightly more behaviours of “Supporting or Agreeing” (42% vs. 34%), but less of “Giving Information” (43% vs. 53%) than when the female patients go unaccompanied, predominating these two types of behaviours in both modalities. Consultation with female patients with a companion shows almost twice as many verbal behaviours of the doctor vs. the consultation with unaccompanied women (186 vs. 100), and is longer (6.4 ' vs. 7.7'). Conclusions: This study shows that consultations of female patients with a companion are longer and more verbal behaviours are performed. In patients female the triadic consultations have more agreements, but less information is obtained than in the dyadic, and in general there is mixed results. Female patients show a clear predominance of verbal behaviours of “Giving information” and “Supporting or Agreeing”, both with or without companion in the consultation.

Radon Testing: Community Engagement By a Rural Family Medicine Office.

Iowa has the highest average radon concentrations in the nation, with an estimated 400 radon-induced lung cancer deaths each year. Radon is the second leading cause of lung cancer death overall. The objectives of this study were (1) to educate the population attending a family medicine office about the dangers of radon, (2) to encourage homeowners to test for radon, (3) to work with the community to identify resources for mitigation, and (4) to assess the utility of working with a local family medicine office as a model that could be adopted for other communities with high home radon concentrations. Participants obtained a US Environmental Protection Agency-certified activated charcoal short-term radon kit through their primary care office or by attending a seminar held by their medical office. Participants completed a short investigator-developed questionnaire about their home, heating, and demographics. Of 746 radon kits handed out, 378 valid results (51%) were received, of which 351 questionnaires could be matched to the kit results. The mean radon result was 10.0 pCi/L (standard deviation, 8.5 pCi/L). A radon result of 4 pCi/L or higher, the Environmental Protection Agency action level for mitigation, was found in 81% of homes (n = 285). Four of 5 homes tested had elevated radon levels. This family medicine office/university collaborative educational model could be useful for educating patients about other environmental dangers.

Decisional conflict and vaccine uptake: cross-sectional study of 2012/2013 influenza season in Croatia.

IntroductionAs scientific, media and individual opinions on the need for seasonal influenza vaccination differ, we explored patients’ decisional conflict and perceived physician and social support when making a vaccination choice.Material and methodsWe conducted a survey of patients with previous vaccination experience in a single family medicine office in Split, Croatia. The questionnaire included the Decisional Conflict Scale (DCS), perceived social support, and attitudes and knowledge concerning vaccination.ResultsOut of 203 (86%) adult patients with previous vaccination experience, 182 (40.4%) opted to vaccinate in the current season, 98 (48.3%) refused, and 22 (11.3%) were undecided. The median decisional conflict score was highest among those undecided (43.8 out of the maximum 100, interquartile range (IQR) 33.2–52.3), lowest among those opting to vaccinate (17.2, IQR 9.4–26.6), and intermediate among those who refused vaccination (25.0, IQR 17.2–39.1) (p < 0.001, Kruskal-Wallis test and post-hoc Mann-Whitney U tests). The most common self-reported reasons for vaccination were previous vaccination experience (n = 85, 42%) and media information (n = 62, 30%). Those who refused vaccination felt less satisfied with the support they received from their family physician than those who decided to vaccinate (median 6.5 (IQR 0–9) vs. 9 (IQR 5–10) on a scale from 0 to 10), respectively; p = 0.001, Mann-Whitney U test).ConclusionsHigher decisional conflict of patients who refuse influenza vaccination and those undecided, alongside their perceived low support of the family physician in making that choice, emphasize the importance family doctors play in advising and helping patients make informed decisions about seasonal influenza vaccination.

Patient factors associated with documented provision of JNC 7-recommended hypertension care at an academic family medicine office.

Little is known about patient factors associated with the provision of hypertension care as recommended by JNC 7. We conducted a retrospective chart review (n = 150) to compare documented provision of items recommended by JNC 7 with various patient factors, using a 15-point scoring tool (0% to 100%). The overall documentation of JNC guideline-recommended care was 78.3%. There was a significant effect of marital status; married patients received more guideline-recommended care than unmarried patients (80.4% vs 74.4%; P = .02). Men received more guideline-recommended care than women (80.7% vs 76.4%; P = .02). Multivariate analysis revealed that Medicaid patients had 7.1% lower rates of guideline-recommended care than patients with other insurance (P = .05). There was no significant difference in guideline-recommended care based on race/ethnicity; however, racial/ethnic disparities were identified for certain individual standards. Hypertension care in 2013 at an academic family medicine center was, for the most part, in agreement with guidelines; however, provision of some items varied based on sex, marital status, and insurance. Awareness of these predictors may help improve the implementation of guidelines, particularly relevant given the recent release of JNC 8.

Assessing and Documenting the Cognitive Performance of Family Medicine Residents Practicing Outpatient Medicine.

Development of cognitive skills for competent medical practice is a goal of residency education. Cognitive skills must be developed for many different clinical situations. We developed the Resident Cognitive Skills Documentation (CogDoc) as a method for capturing faculty members' real-time assessment of residents' cognitive performance while they precepted them in a family medicine office. The tool captures 3 dimensions of cognitive skills: medical knowledge, understanding, and its application. This article describes CogDoc development, our experience with its use, and its reliability and feasibility. After development and pilot-testing, we introduced the CogDoc at a single training site, collecting all completed forms for 14months to determine completion rate, competence development over time, consistency among preceptors, and resident use of the data. Thirty-eight faculty members completed 5021 CogDoc forms, documenting 29% of all patient visits by 33 residents. Competency was documented in all entrustable professional activities. Competence was statistically different among residents of different years of training for all 3 dimensions and progressively increased within all residency classes over time. Reliability scores were high: 0.9204 for the medical knowledge domain, 0.9405 for understanding, and 0.9414 for application. Almost every resident reported accessing the individual forms or summaries documenting their performance. The CogDoc approach allows for ongoing assessment and documentation of resident competence, and, when compiled over time, depicts a comprehensive assessment of residents' cognitive development and ability to make decisions in ambulatory medicine. This approach meets criteria for an acceptable tool for assessing cognitive skills.

The Herzl Patient Health Information Service: An innovative solution to the problem of informing patients in primary care

The Herzl Patient Health Information Service was intended to address known difficulties of informing patients in primary care, namely time, tools, and training [1–3]. The addition of a health information professional (HIP) to the healthcare team reduced the burden of informing patients for health professionals (HP), facilitated access to resources, and provided instructional support. Patients and families who receive information are better able to participate in healthcare decisions and have improved health outcomes and increased satisfaction with their care [4–14]. A proliferation of online health information makes it difficult for patients and families to navigate to the most reliable and up-to-date information. Low literacy and health literacy as well as lack of the internet can be barriers to accessing information [7, 16–18]. Language and culture are further confounding factors [7, 19–21]. HPs may not have the time, know where to look for consumer health information, and (or) are not always trained or able to identify patient needs and preferences regarding decision-making or information [2, 14, 22]. HIPs have been developing and providing access to consumer health information for at least 40 years [23–28]. Recent trends see HIPs moving away from the traditional library environment towards meeting the needs of our users in the field [29–33], although our role continues to be relatively peripheral to the HP2patient dyad. HIPs must work to become fully integrated into the healthcare team by establishing for ourselves a trusted role alongside HPs and by engaging with patients at the point-of-care. Patient-centred care and shared decision-making, with their emphasis on information exchange, would benefit from the participation of HIPs at the point-of-care. The Herzl Family Practice Centre is a family medicine clinic and a site for clinical training in family medicine office practice at the McGill-affiliated Jewish General Hospital in Montreal. In the past, a nurse with some hours devoted to patient education and a hospital library with a patient resource centre were not, in themselves, sufficient to address patients’ information needs. Further, in the gap between Herzl’s previous patient education initiative and the pilot in question, the patient education nurse had retired, the ‘‘pamphlet room’’ had been appropriated by the clinic for other purposes, and a pamphlet database developed by the library had fallen into disuse due to lack of online access and a cumbersome search interface. Few Herzl staff members were aware of the library or the Patient and Family Resource Centre (PFRC). To revitalize the Herzl’s patient education initiative and address patient information needs, a pilot was implemented that embedded an HIP at point-of-care with access to library and PFRC resources. In this paper, this initiative and the barriers that impeded full integration are described.

Hand hygiene and face touching in family medicine offices: a Cincinnati Area Research and Improvement Group (CARInG) network study.

Family medicine offices may play an important role in the transmission of common illnesses such as upper respiratory tract infections (URTIs). There has, however, been little study of whether physicians teach patients about URTI transmission and what their own actions are to prevent infection. The purpose of this study was to assess the quality of hand hygiene and the frequency with which family physicians and staff touch their eyes, nose, and mouth (the T-zone) as well as physician and staff self-reported behaviors and recommendations given to patients regarding URTI prevention. We observed family physicians and staff at 7 offices of the Cincinnati Area Research and Improvement Group (CARInG) practice-based research network for the quality of hand hygiene and number of T-zone touches. After observations, participants completed surveys about personal habits and recommendations given to patients to prevent URTIs. A total of 31 clinicians and 48 staff participated. They touched their T-zones a mean of 19 times in 2 hours (range, 0-105 times); clinicians did so significantly less often than staff (P < .001). We observed 123 episodes of hand washing and 288 uses of alcohol-based cleanser. Only 11 hand washings (9%) met Centers for Disease Control and Prevention criteria for effective hand washing. Alcohol cleansers were used more appropriately, with 243 (84%) meeting ideal use. Participants who were observed using better hand hygiene and who touched their T-zone less report the same personal habits and recommendations to patients as those with poorer URTI prevention hygiene. Clinicians and staff in family medicine offices frequently touch their T-zone and demonstrate mixed quality of hand cleansing. Participants' self-rated URTI prevention behaviors were not associated with how well they actually perform hand hygiene and how often they touch their T-zone. The relationship between self-reported and observed behaviors and URTIs in family medicine office settings needs further study.

Evaluation of provider documentation of medication management in a Patient-Centered Medical Home (PCMH)

Purpose: The National Committee for Quality Assurance (NCQA) has standards for recognizing Patient-Centered Medical Homes (PCMH) including one for medication management. Study objectives were to identify if and how providers within a PCMH recognized under the 2008 guidelines were documenting components of medication management to meet NCQA's 2011 requirements including: 1) providing information about new prescriptions to &gt;80% of patients; 2) assessing understanding of medications for &gt;50% of patients; and 3) assessing response and barriers to medication adherence for &gt;50% of patients.&#x0D; Methods: Physician and pharmacist-led patient visits from a family medicine office, from February 1 to August 1, 2012 were assessed. Patients over 18 years old taking at least one medication were included. A retrospective chart review was performed to assess documented components of medication management. Descriptive statistics were used to analyze data.&#x0D; Results: A systematic sampling of 450 physician-led and 195 pharmacist-led patient visits, demonstrated providers did not meet documentation goals for providing patients information on new prescriptions (65% pharmacist, 24% physician, 36% of total provider notes) or for assessment of patients' understanding of medications (9% pharmacist 12% physician, 11% of total provider notes). Individually each type of provider did not meet the goal of assessing patient response and barriers to adherence to medication, but with combined intervention by the pharmacists and the physicians, the site was able to surpass NCQA's percentage goal (57% and 58%).&#x0D; Conclusions: No components of medication management are well documented. Using the electronic medical record, pharmacists may be able to develop documentation tools and assist sites to meet NCQA's goals for medication management.&#x0D; &#x0D; Type: Original Research

Correction to "Does the 'Office Nurse' Level of Training Matter in the Family Medicine Office?"

Correction to "Does the 'Office Nurse' Level of Training Matter in the Family Medicine Office?"

Does the "Office Nurse" Level of Training Matter in the Family Medicine Office?

The "office nurse" or clinical associate (registered nurse [RN], licensed practical nurse[LPN], or medical assistant [MA]) is a key member of the family medicine care team, but little is known about the influence of their level of training on team performance. The performance of the clinical dyad (clinician and associate) was studied in relation to the level of training of the nurse. The dyad's performance was measured by the performance indicators of diabetes scores, patient satisfaction, and productivity. Dyads with a RN scored higher in meeting all 5 of the diabetes quality indicators (27.8%) than those with a LPN (19.3%) or an MA (14.7%). For patient satisfaction, the RN dyads also scored higher than the other dyad groups (positive responses: RN, 96.8%; LPN, 95.5%; MA, 94.6%). Productivity was the same in all groups. Better diabetes performance was seen in those practices with fewer competing demands: nonrural versus rural (22.2% vs 15.1%, respectively), and those not doing obstetrics versus those doing obstetrics (20.3% vs 15.1%, respectively), and for physicians versus associate providers (18.8% vs 15.1%, respectively). Higher patient satisfaction was observed in those dyads who were nonrural verus rural (96.6 vs 94.1%), among those doing obstetrics (96.0% vs 94.9%), and in physicians verus associate providers (95.7% vs 93.2%). The number of years working with the same clinician was twice as high for RNs (6.63) and LPNs (6.57) than for MAs (3.29). A higher level of education of the clinical associate seems to confer skills that enhance the care team's management of chronic illness such as diabetes. This could potentially decrease the practice burden on other team members while facilitating the team's objectives in meeting quality indicators.

Mental Health Care Treatment Initiation When Mental Health Services Are Incorporated Into Primary Care Practice

Most primary care patients with mental health issues are identified or treated in primary care rather than the specialty mental health system. Primary care physicians report that their patients do not have access to needed mental health care. When referrals are made to the specialty behavioral or mental health care system, rates of patients who initiate treatment are low. Collaborative care models, with mental health clinicians as part of the primary care medical staff, have been suggested as an alternative. The aim of this study is to examine rates of treatment startup in 2 collaborative care settings: a rural family medicine office and a suburban internal medicine office. In both practices referrals for mental health services are made within the practice. Referral data were drawn from 2 convenience samples of patients referred by primary care physicians for collaborative mental health treatment at Fletcher Allen Health Care in Vermont. The first sample consisted of 93 consecutively scheduled referrals in a family medicine office (sample A) between January 2006 and December 2007. The second sample consisted of 215 consecutive scheduled referrals at an internal medicine office (sample B) between January 2009 and December 2009. Referral data identified age, sex, and presenting mental health/medical problem. In sample A, 95.5% of those patients scheduling appointments began behavioral health treatment; in sample B this percentage was 82%. In sample B, 69% of all patients initially referred for mental health care both scheduled and initiated treatment. When referred to a mental health clinician who provides on-site access as part of a primary care mental health collaborative care model, a high percentage of patients referred scheduled care. Furthermore, of those who scheduled care, a high percentage of patients attend the scheduled appointment. Findings persist despite differences in practice type, populations, locations, and time frames of data collection. That the findings persist across the different offices suggests that this model of care may contain elements that improve the longstanding problem of poor treatment initiation rates when primary care physicians refer patients for outpatient behavioral health services.

Health Literacy Assessment via STOFHLA

Background . Low health literacy affects more than one-third of American adults, resulting in poor physician-patient communication, worse health outcomes, and increased medical costs. Many physicians are uninformed of their patients’ health literacy status. Current paper-based surveys require extra staff, time, and resources for administration, while a computer-based survey may provide efficient assessment to increase provider awareness. The study assessed the efficacy of a computer-based health literacy test compared to an established, paper-based format for use in an office setting. Methods . A prospective, non-blinded, randomized experimental design was conducted. A brief demographic survey and health literacy test (STOFHLA) was administered to 100 adult subjects at a Midwestern family medicine residency clinic. Recruitment flyers were distributed in the office and all eligible, willing patients were randomized to one of two groups. Fifty participants were administered the paper test and 50 were administered the computer-based test. Results. The majority of subjects had “adequate” health literacy (85%) and completed the test within the allotted time period (82%). When comparing the paper and computer groups, there were no statistically significant differences for demographics, test scores, or completion time. Conclusions . A computer-based health literacy test is as effective as an established, paper-based format to assess health literacy in a family medicine office population. Future research studies should investigate the impact of having patient health literacy scores available to the physician prior to the office visit and how it may affect communication, compliance, and health outcomes. KJM 2011; 4(3):55-61.

Pharmacist integration into the medical home: Qualitative analysis

To determine the acceptance and attitudes of family medicine physicians, clinical and nonclinical office staff, pharmacists, and patients during pharmacist integration into a medical home. Qualitative study. Pittsburgh, PA, area from August 2009 to June 2010. Physicians, staff, pharmacists, and patients at four single-specialty family medicine office practices functioning as medical homes. Attitudes, acceptance, barriers, and problems identified by participants. A total of 84 interviews were conducted: 21 interviews with family medicine physicians, 26 with patient care staff, 9 with nonclinical staff, 13 with patients, 6 with pharmacists, and 8 with office managers. Five main themes emerged from each group regarding the integration of a pharmacist, including positive overall feeling; clinical, educational, and time-saving benefits to the various groups; challenges understanding the role of the pharmacist; improved workflow and integration resulting from pharmacist flexibility and motivation; and suggestions to increase the pharmacists' time in each office. Pharmacists felt that they were accepted within 6 months of the integration process and that time management was a challenge. Participants felt that inclusion of a pharmacist into their practice improves the quality of patient care, provides a valuable resource for all providers and staff, and empowers patients. The initial concerns of the clinical and nonclinical staff disappeared within the first months of pharmacist integration. These results provide guidance to clinicians and insight into strategies for building a pharmacist-integrated medical home team.

Treatment of Cervical Dysplasia with the Fischer Cone Biopsy Excisor in a Family Medicine Office: A Case Series

The purpose of this study was to evaluate the use of the Fischer cone biopsy excisor (FCBE) as the primary electrode for treatment of cervical dysplasia in a family medicine office. Retrospective analysis of cervical electrosurgical excision procedures in patients with cervical intraepithelial neoplasia (CIN) performed in our Family Medicine Center between 2002 and 2005. We reviewed 91 cases. Indication for excision was >or=CIN II in 86.8% of the patients. In the FCBE group (n = 86), 95% of the specimen margins were negative for dysplasia, 90% had no reported thermal artifact, and 81% were submitted unfragmented. In the FCBE and the loop electrosurgical excision procedure (LEEP) group (n = 5), 4 of the 5 specimens' margins were negative for dysplasia. Reported complications included palpitations or flushing during cervical block (32%), pain (9%), and heavy bleeding (3%). In this case series the use of the FCBE with or without the LEEP in a family medicine office provided a high rate of negative margins for dysplasia and a low rate of fragmentation and thermal artifact. Family physicians who perform LEEP can also use the FCBE safely in their offices to treat cervical dysplasia.

The Glass is Half Full: Geriatric Precepting Encounters in Family Medicine

Approximately 19% to 20% of all family medicine office visits involve care to patients older than age 65, yet limited research addresses family medicine geriatric education in the outpatient setting. This study explored how geriatric content is incorporated into resident/attending precepting encounters, using direct observation. An observer recorded the content of 259 sequential precepting interactions, including 33 encounters involving patients older than age 64. Eighty-five percent of these 33 encounters included discussion of a geriatric issue. Although precepting encounters for geriatric and nongeriatric patients were of similar length, more time was spent during geriatric encounters discussing functional issues. We conclude that resident continuity clinics are a source of geriatric education.

A Typical Day in the Family Medicine Office

Clinical medicine and prevention in primary care practice are the themes of this issue, wherein we present new research with practical information on common subjects: cardiovascular outcomes with specific medications, vitamin D, calcium supplements, vaginitis, smoking, stroke and allergies,

The Communication between the Family Doctor and the Specialist Physician

The communication between the family doctor and the specialist is initiated when there are cases of affections seldom seen in the current practice of family medicine or when they are away of the regular pattern of diagnosis and treatement. The family doctor makes a referral paper where he requests the clarification of the elements mentioned above, the answer being the medical letter. This document has to comprise the diagnosis (its formulation and its supporting elements), the treatement (therapeutic objective, inital treatement) and the dispensarisation (its rythm, follow-up elements, indicators of satisfactory evolution and alarm signals). The functions of the medical letter are both the funding of the long term treatement, within the family medicine office, and the centralisation of the medical information regarding the respective pacient. Keywords: family doctor, medical communication, medical letter, therapeutic objective, dispensarisation Content available only in Romanian.

Effect of Antibiotics on Vulvovaginal Candidiasis: A MetroNet Study

Vulvovaginal candidiasis (VVC) is believed common after systemic antibiotic therapy, yet few studies demonstrate this association. In this pilot study, we evaluate the effect of short-course oral antibiotic use on VVC. Nonpregnant women aged 18 to 64 years who required >or=3 days oral antibiotics for nongynecological diseases were recruited from a family medicine office. Age-matched (+/-5 years) women seen in the same clinic for noninfectious problems were recruited as controls. The main outcomes are incidence of symptomatic VVC and prevalence of positive vaginal Candida culture 4 to 6 weeks after antibiotics. Eighty (44 in antibiotic group) women were recruited; 14 of 79 (95% CI, 0.11-0.28) had asymptomatic vaginal Candida cultures positive at baseline. During follow-up, 10 of 27 (95% CI, 0.22-0.56) women in antibiotic group were Candida culture positive. In contrast, 3 of 27 (95% CI, 0.04-0.28) women in the control group were Candida culture positive (relative risk, 3.33; P = .03). Meanwhile, 6 of 27 (95% CI, 0.11-0.41) women in antibiotic group developed symptomatic VVC whereas none (95% CI, 0-0.12) of the women in the control group developed vaginal symptoms (relative risk, infinity; P = .02). Baseline Candida culture did not predict subsequent symptomatic VVC after antibiotics. In this pilot study, the use of short courses of oral antibiotics seems to increase prevalence of asymptomatic vaginal Candida colonization and incidence of symptomatic VVC. Larger cohort studies are needed to confirm these findings.

Do antibiotics affect the quality of life of patients with upper respiratory tract illnesses?: it might depend on one’s luck

Upper respiratory tract illnesses (URTI) are known to cause measurable decline in health-related quality of life (HRQL). We studied whether antibiotics impacted patients' HRQL after obtaining medical care for URTI. Adults seeking care for URTI at a family medicine office were eligible for this study. Decisions to prescribe antibiotics were left to their physicians. Subjects completed the Quality of Well-Being questionnaire on enrolment and on days 3, 7, 14 and 28. Analysis of HRQL was undertaken using repeated measures ANOVA and ANCOVA. Seventy-three patients (mean age 35.8 years) were studied. Thirty-six of the subjects (50.7%) received prescriptions for antibiotics from their physicians at the index visit. By day 28, 78.4% of the subjects in the antibiotic group and 77.8% of the other group reported cure (p = 0.95). Receiving a prescription for an antibiotic at the initial visit did not influence subsequent HRQL reported by subjects (p = 0.98). However, when subjects receiving antibiotics were subgrouped by whether they reported an antibiotic adverse event we found significant differences in final HRQL. Subjects receiving antibiotics but not experiencing adverse events reported higher HRQL by day 28 than did subjects receiving an antibiotic but also reporting adverse events and subjects not receiving any antibiotics (p = 0.02). Providing patients experiencing URTIs with prescriptions for antibiotics does not, on average, positively impact HRQL over the following 28 days. However, the subgroup of patients who receive antibiotics and do not experience an adverse event may come out ahead.