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\title{Patients Attitudes and Beliefs about using Drugs for Sore Throat in Primary Care}
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\begin{document}

             \author[1]{Dr. MuhteAem Erol  Yayla}

             \author[2]{Dr. Elif Binen  Yilmaz}

             \affil[1]{  Ministery of health,Turkey}

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\date{\small \em Received: 11 December 2012 Accepted: 31 December 2012 Published: 15 January 2013}

\maketitle


\begin{abstract}
        


Sore throat is a symptom developes by inflammation of pharynx, tonsilla and nasopharynx. In this survey, we investigate, patients' beliefs and attitudes towards receiving prescription for sore throat in a primary care center. Materials and Methods: We enrolled 300 patients attending to two family medicine centers in Afyon and in Adana, for sore throat between 1.12.2012 and 31.12.2012. All participants were informed about the content of the survey; and after obtaining concent of the survey, questionnaire with 8 questions were given.Results : We enrolled eligible 173 female (57,7%), 127 male (42,3%) patients attended to primary care. 179 patients(59.7%) found antibiotics beneficial in every sore throat, 172 patients(57.3 %) found gargles/mouthwashes and sprays beneficial in every sore throat. Question 3 was looking for an answer to "Even though your doctors advice you not to use, in which conditions you would like to use antibiotics?".136(45.4%) patients notice complete thrust in their phsician answer as "I do not use antibiotics if doctors find it inappropriate". Excessive fatigue ( n=56, 18.7% ), fever (n=38, 12.7% ), cough( n=23, 7.7% ), sputum( n=17, 5.7% ), sore throat ( n=16, 5.3% ), inflammation( n=8, 2.7% ), if I have to( n=6, 2% ) were the other answers. 228 patients (76 %) found doctors' prescription af antibiotics appropriate, 233 patients (77.7 %) found doctors' prescription of gargles/mouthwashes and sprays as appropriate.

\end{abstract}


\keywords{pharyngitis, drug utilization, drug prescriptions.}

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\let\tabcellsep& 	 	 		 
\section[{Introduction}]{Introduction}\par
ore throat is a symptom developes by inflammation of pharynx, tonsilla and nasopharynx. Adults have upper respiratory infection for 2 to 4 times per year, and children have 6 to 8 times per year during the colder months of the year \hyperref[b0]{(1)}. Viruses are the cause of 50\% to 80 \% of sore throat caused by infections including influenza and herpes simplex virus. Additional 1-10 \% infection cause is EBV. 5-36\% infection cause is group A beta haemolytic streptoccus which is the most common bacterial infection cause \hyperref[b1]{(2)}.\par
Researchs show that there are many misconceptions among the general public regarding the effectiveness and appropriate indications for the use of Author ? : Family Medicine Specialist, Family Medicine Center No:5 /Afyon, Turkey. E-mail : meyayla76@yahoo.com Author ? : Family Medicine Specialist, Sar?çam Family Medicine Center /Adana, Turkey.\par
antibiotics. \hyperref[b2]{[3]} On the other hand, GPs are overestimating the number of patients who are actually demanding antibiotics. Studies suggest that this overestimation of "patients' prescribing pressure" is largely based on patients' concerns about the seriousness of their disease \hyperref[b3]{(4,}\hyperref[b4]{5)}.\par
Studies investigating knowledge about antibiotic treatment issues among the general public are not much \hyperref[b5]{(6)}\hyperref[b6]{(7)}\hyperref[b7]{(8)}\hyperref[b8]{(9)}\hyperref[b9]{(10)}\hyperref[b10]{(11)}\hyperref[b11]{(12)}. In our survey, we investigate, patients' beliefs and attitudes towards receiving prescription for sore throat in a primary care center. 
\section[{II.}]{II.} 
\section[{Methods}]{Methods}\par
We enrolled 300 patients attending to two family medicine centers in Afyon and in Adana, for sore throat between 1.12.2012 and 31.12.2012. All participants were informed about the content of the survey; and after obtaining concent of the survey, questionnaire with 8 questions were given. All participants answered questions by themselves. All questions had one answer except 3rd question. Participants were free in answering multiple in this question.\par
Limitations of Study: Study was performed just among patients that is not illeterate. 
\section[{III.}]{III.} 
\section[{Results}]{Results}\par
We enrolled eligible 173 female (57,7\%), 127 male (42,3\%) patients attended to primary care. 132 patients (44\%) were 21 to 30 years old, 71 patients (\%23,7) were 31 to 40 years old, 59 patients (\%19,7) were 10 to 20 years old, 38 patients (\%12,6) were over 41 years old.\par
88 patients (29,3 \%) were graduaded from high school, 85 (28,3\%) were graduaded primary school, 65 (21,6 \%) were graduaded univercity or vocational high school and 62 (20,7 \%) were graduaded from secondary school.\par
Question 1 and 2 were about if patients find antibiotics and gargles/mouthwashes and sprays benificial in every sore throat. 179 patients (59.7\%) found antibiotics beneficial in every sore throat, 172 patients (57.3 \%) found gargles/mouthwashes and sprays beneficial in every sore throat.\par
Question 3 was looking for an answer to "Even though your doctors advice you not to use, in which conditions you would like to use antibiotics?".136 patients (45.4\%) notice complete thrust in their phsician and answer this as "I do not use antibiotics if doctors find it inappropriate". Excessive fatigue (n=56, 18.7\%), fever (n=38, 12.7\%), cough (n=23, 7.7\%), sputum (n=17, 5.7\%), sore throat (n=16, 5.3\%), inflammation (n=8, 2.7\%), if I have to (n=6, 2\%) were the other answers.\par
In \par
IV. 
\section[{Discussion}]{Discussion}\par
General practice consultation data indicate that young women have a higher consultation rate than other groups of patients \hyperref[b12]{(13)}. Our attending patients' rates of women/men ratio (173/127) and age group (44\% patients were 21 to 30 years old) were consistent with this data.\par
Half of our subjects (50,9\%) were graduaded from high school or higher grades. While patients' answering questions about what they really think about doctors' prescribing drugs were important, so illeterate subjects did not enrolled in the study and let participants answer questions by themselves.\par
Absence of cough, swelling and enlargement of anterior cervical lymph nodes, sore throat, ?38,3 fever(100.9 F), exudate of tonsillas and pharynx, exposure to Streptococcus in two weeks leads to group A streptococcus infection. Palatale petechia, scarlatiniforme rush are highly spesific but unfrequent findings. Sometimes swollen uvula may be encountered. Cough, rhinorrhea, conjuntivitis and diarrhea are frequent in viral pharyngitis \hyperref[b13]{(14)}.\par
Excessive fatigue for 18.7 \% of subjects and cough for 7.7 \% participants are known as an indication for antibiotic usage, even though their doctors advice versus. Fever is also in favor of antibiotic prescription as 12.7 \% subjects assume likewise.\par
Even though most causes of sore throat is virus, most of participants (59,7\%) were believing that antibiotics are effective in every sore throat, but contradiction to that, as seen on 3rd and 4th questions, they count on their physicians prescription appropriateness.\par
V. 
\section[{Conclusion}]{Conclusion}\par
Turkish primary care patients living in the rural parts of those two cities count on their doctors mostly, but yet they need to be informed about antibiotic indications in sore throat.\begin{figure}[htbp]
\noindent\textbf{1} \par 
\begin{longtable}{}
\end{longtable} \par
 
\caption{\label{tab_0}Table 1 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.6763440860215053\textwidth}P{0.06702508960573476\textwidth}P{0.10663082437275985\textwidth}}
?\tabcellsep n\tabcellsep \%\\
Yes\tabcellsep 179\tabcellsep 59.7\\
I am not sure\tabcellsep 97\tabcellsep 32,3\\
No\tabcellsep 12\tabcellsep 4\\
Sometimes\tabcellsep 11\tabcellsep 3,7\\
I am not using antibiotics for sore throat\tabcellsep 1\tabcellsep 0,3\\
2.Do you find beneficial to use gargles/mouthwashes and sprays?\tabcellsep N\tabcellsep \%\\
Yes\tabcellsep 172\tabcellsep 57,3\\
I am not sure\tabcellsep 60\tabcellsep 20\\
No\tabcellsep 41\tabcellsep 13,7\\
Sometimes\tabcellsep 22\tabcellsep 7,3\\
I am not using gargles/mouthwashes and sprays for sore throat\tabcellsep 5\tabcellsep 1,7\\
3\tabcellsep \tabcellsep \end{longtable} \par
 
\caption{\label{tab_1}1.Do you think antibiotics are beneficial for every sore throat}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.7031413612565445\textwidth}P{0.06007853403141362\textwidth}P{0.08678010471204188\textwidth}}
\tabcellsep N\tabcellsep \%\\
I don't use antibiotics if doctors find it inappropriate\tabcellsep 136\tabcellsep 45,4\\
Excessive fatigue\tabcellsep 56\tabcellsep 18,7\\
Fever\tabcellsep 38\tabcellsep 12,7\\
Cough\tabcellsep 23\tabcellsep 7,7\\
Sputum\tabcellsep 17\tabcellsep 5,7\\
Sore throat\tabcellsep 16\tabcellsep 5,3\\
Inflammation\tabcellsep 8\tabcellsep 2,7\\
If I have to\tabcellsep 6\tabcellsep 2\\
4.Do doctors prescribe in suitable conditions?\tabcellsep N\tabcellsep \%\\
They prescribe for suitable conditions\tabcellsep 228\tabcellsep 76\\
They prescribe all the time\tabcellsep 29\tabcellsep 9,7\\
I am not sure\tabcellsep 21\tabcellsep 7\\
They prescribe for inappropriate conditions\tabcellsep 18\tabcellsep 6\\
I don't use antibiotics\tabcellsep 4\tabcellsep 1,3\\
5.\tabcellsep \tabcellsep \end{longtable} \par
 
\caption{\label{tab_2}.Even though your doctors advice you not to use,in which conditions you would like to use antibiotics?}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.7489189189189189\textwidth}P{0.050540540540540545\textwidth}P{0.050540540540540545\textwidth}}
\tabcellsep n\tabcellsep \%\\
They prescribe for suitable conditions\tabcellsep 233\tabcellsep 77,7\\
They prescribe all the time\tabcellsep 33\tabcellsep 11\\
I am not sure\tabcellsep 14\tabcellsep 4,7\\
They prescribe for inappropriate conditions\tabcellsep 12\tabcellsep \\
I don't use gargles/mouthwashes and sprays\tabcellsep 8\tabcellsep \end{longtable} \par
 
\caption{\label{tab_3}What do you think about your doctors' attitude of prescribing gargles/mouthwashes and sprays?}\end{figure}
 			\footnote{( )B} 		 		\backmatter  			  				\begin{bibitemlist}{1}
\bibitem[Belongia et al. ()]{b10}\label{b10} 	 		‘Antibiotic use and upper respiratory infections: a survey of knowledge, attitudes, and experience in Wisconsin and Minnesota’.  		 			E A Belongia 		,  		 			T S Naimi 		,  		 			C M Gale 		.  	 	 		\textit{Prev Med}  		2002. 34 p. .  	 
\bibitem[Mcnulty et al. ()]{b6}\label{b6} 	 		‘Don't wear me out-the public's knowledge of and attitudes to antibiotic use’.  		 			C A Mcnulty 		,  		 			P Boyle 		,  		 			T Nichols 		.  	 	 		\textit{J Antimicrob Chemother}  		2007. 59 p. .  	 
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\bibitem[General Practitioner Workload (2004)]{b12}\label{b12} 	 	 	 		\textit{General Practitioner Workload},  				 (London)  		April 2004. 2004. Royal College of General Practitioners.  	 
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\end{bibitemlist}
 			 		 	 
\end{document}
