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Arch Pediatr Adolesc Med. 2006 Sep;160(9):945-52.

Ruling out the need for antibiotics: are we sending the right message?

Author information

1
Department of Pediatrics, University of California-Los Angeles, Calif, USA. ritams@u.washington.edu

Abstract

OBJECTIVES:

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.

DESIGN:

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.

SETTING:

Twenty-seven pediatric practices in Los Angeles, Calif.

PARTICIPANTS:

Thirty-eight pediatricians and 522 consecutively approached parents of children with cold symptoms.

MAIN OUTCOME MEASURES:

Physicians' perceptions of parental expectations for antibiotics, inappropriate antibiotic prescribing, and parental questioning of nonantibiotic treatments.

RESULTS:

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%).

CONCLUSIONS:

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.

PMID:
16953018
DOI:
10.1001/archpedi.160.9.945
[Indexed for MEDLINE]

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