Categorical Risk Perception Drives Variability in Antibiotic Prescribing in the Emergency Department: A Mixed Methods Observational Study

Abstract

Our results indicate that clinicians who perceive prescribing as a categorical choice between patients remaining ill or possibly improving from therapy are more likely to prescribe antibiotics. However, this strategy assumes that antibiotics are essentially harmless. Clinicians who framed decision-making as a choice between potential harms from therapy and continued patient illness (e.g., increased appreciation of potential harms) had lower prescribing rates. These results suggest that interventions to reduce inappropriate prescribing should emphasize the non-negligible possibility of serious side effects.

Assessing causal claims about complex engineered systems with quantitative data: internal, external, and construct validity

“…In the domain of antibiotic overuse, Broniatowski et al . and Klein et al . used quantitative observational survey methods to demonstrate that patients and health‐care providers perceive decisions to take or prescribe antibiotics as analogous to a risky‐choice framing problem.…”

“…For example, Broniatowski et al . and Klein et al . performed exploratory factor analyses to differentiate between different gist representations about antibiotic use.…”

“…25 How are we to know if FTT's predictions are valid? The internal validity of FTT has been established through multiple laboratory experiments, [26][27][28][29][30] In the domain of antibiotic overuse, Broniatowski et al 34 and Klein et al 35 used quantitative observational survey methods to demonstrate that patients and health-care providers perceive decisions to take or prescribe antibiotics as analogous to a risky-choice framing problem. Additionally, Broniatowski et al 36 conducted a retrospective observational study showing that gist and verbatim information made distinct contributions to the likelihood that news articles about vaccination were shared on Facebook, supporting FTT's predictions about the parallel encoding of these mental representations.…”

“…Given multiple measures, a factor analysis can be used to determine the extent to which items are convergent or divergent. ¶ For example, Broniatowski et al 34 and Klein et al 35 performed exploratory factor analyses to differentiate between different gist representations about antibiotic use.…”

Capsule Commentary on Klein et al., Categorical Risk Perception Drives Variability in Antibiotic Prescribing in the Emergency Department: a Mixed Methods Observational Study

“…1 Clinicians who had survey responses that aligned with what they describe as a Bwhy-not-take-a-risk^gist-probably better described as the Bantibiotics-are-low-risk-and-the-patient-won't-get-betterwithout-them^gist-had higher antibiotic prescribing. Clinicians who had survey responses that aligned with an Bantibiotics-may-be-harmful^gist had lower antibiotic prescribing.…”