Ruling out the need for antibiotics - Are we sending the right message?

Department of Pediatrics, University of California, Los Angeles, Los Ángeles, California, United States
Archives of Pediatrics and Adolescent Medicine (Impact Factor: 5.73). 09/2006; 160(9):945-52. DOI: 10.1001/archpedi.160.9.945
Source: PubMed


To examine the relationships among physician-parent communication practices, physicians' perceptions of parental expectations for antibiotic treatment, and inappropriate antibiotic prescribing for viral upper respiratory tract infections.
Cross-sectional study of pediatric encounters motivated by cold symptoms between October 1, 2000, and June 30, 2001. Each encounter was videotaped. Physicians completed a postvisit survey that measured whether they perceived the parent as expecting antibiotics. Coded communication variables were merged with survey variables. Multivariate analyses identified key predictors of parent-physician communication practices, physician perceptions of parents' expectations for antibiotics, and inappropriate antibiotic prescribing for viral conditions.
Twenty-seven pediatric practices in Los Angeles, Calif.
Thirty-eight pediatricians and 522 consecutively approached parents of children with cold symptoms.
Physicians' perceptions of parental expectations for antibiotics, inappropriate antibiotic prescribing, and parental questioning of nonantibiotic treatments.
Physicians were 20.2% more likely to perceive parents as expecting antibiotics when they questioned the physician's treatment plan (P = .004; 95% confidence interval, 6.3%-34.0%). When physicians perceived parents as expecting antibiotics, they were 31.7% more likely to inappropriately prescribe them (P<.001; 95% confidence interval, 16.0%-47.3%). Parents were 24.0% more likely to question the treatment plan when the physician ruled out the need for antibiotics (P = .004; 95% confidence interval, 7.7%-40.3%).
Parental questioning of the treatment plan increases physicians' perceptions that antibiotics are expected and thus increases inappropriate antibiotic prescribing. Treatment plans that focus on what can be done to make a child feel better, rather than on what is not needed, ie, antibiotics, may decrease inappropriate antibiotic prescribing.

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    • "Despite rapid improvement in health care over the past decades, fever continues to be a major cause of admissions, laboratory work-up and antibiotic uses in pediatric outpatient settings (POS) [1,2,3,4]. Fever due to viral infections can be particularly difficult to distinguish from that in children with clinical signs of bacterial infections [5]. "
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    • "According to this analysis, communication skills and diagnostic uncertainty rank among the principal indirect factors influencing antibiotic prescription and may provide an attractive basis for improving prescribing practices. Although physicians reported communication skills as a problem in only five of the studies selected [16] [23] [25] [34] [35], we nevertheless believe that, on the basis of complacency, this factor is an attitude related to patient expectations , in line with published papers which show that improvement in physician–patient communication can reduce patient expectations of antibiotic treatment [61] [62]. In the case of diagnostic uncertainty, the current findings suggest that this may have an indirect impact by influencing physicians' attitudes, such as fear or confidence. "
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    Full-text · Article · Nov 2012 · International journal of antimicrobial agents
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    • "D.J. Opel et al. / Vaccine 30 (2012) 1269– 1275 1271 strep " ) has the effect of implicitly conveying a parent's expectation for antibiotics [35]. Two investigators (JR, JH) separately reviewed each videotape using CA to identify recurrent physician practices of communication regarding immunizations and patterns of parent response to those physician practices. "
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