Communication Practices and Antibiotic Use for Acute Respiratory Tract Infections in Children

Abstract

PURPOSE This study examined relationships between provider communication practices, antibiotic prescribing, and parent care ratings during pediatric visits for acute respiratory tract infection (ARTI).METHODS A cross-sectional study was conducted of 1,285 pediatric visits motivated by ARTI symptoms. Children were seen by 1 of 28 pediatric providers representing 10 practices in Seattle, Washington, between December 2007 and April 2009. Providers completed post-visit surveys reporting on children's presenting symptoms, physical examination findings, assigned diagnoses, and treatments prescribed. Parents completed post-visit surveys reporting on provider communication practices and care ratings for the visit. Multivariate analyses identified key predictors of prescribing antibiotics for ARTI and of parent visit ratings. RESULTSSuggesting actions parents could take to reduce their child's symptoms (providing positive treatment recommendations) was associated with decreased risk of antibiotic prescribing whether done alone or in combination with negative treatment recommendations (ruling out the need for antibiotics) [adjusted risk ratio (aRR) 0.48; 95% CI, 0.24-0.95; and aRR 0.15; 95% CI, 0.06-0.40, respectively]. Parents receiving combined positive and negative treatment recommendations were more likely to give the highest possible visit rating (aRR 1.16; 95% CI, 1.01-1.34).CONCLUSION Combined use of positive and negative treatment recommendations may reduce the risk of antibiotic prescribing for children with viral ARTIs and at the same time improve visit ratings. With the growing threat of antibiotic resistance at the community and individual level, these communication techniques may assist frontline providers in helping to address this pervasive public health problem. INTRODUCTIONA ntibiotic prescribing for childhood acute respiratory tract infections (ARTIs), including acute otitis media, pharyngitis, sinusitis, bronchitis, and upper respiratory infection, is common in the United States. [1][2][3] In the outpatient setting, more than 50% of children diagnosed with ARTIs receive antibiotic prescriptions. 1,3 Considering that the estimated US prevalence of pediatric bacterial ARTIs is 27%, 3 this represents substantial antibiotic overuse nationwide. Unwarranted use of antibiotics is associated with increased resistance among bacteria that commonly cause ARTIs, posing risks to both individuals and communities. [4][5][6][7] Provider-parent communication during visits for viral ARTIs often drives unwarranted antibiotic prescribing. 222A recent qualitative study of parents attending ARTI visits revealed that they expect advice on symptomatic treatment and feel frustrated by recommendations that no treatment is needed. 11 In consonance with these qualitative findings, we previously reported that using negative treatment recommendations significantly increases the likelihood that parents will question non-antibiotic treatment plans. 8 We also found that giving parents a contingency plan (that is, a follow-up ...

Shared decision making in primary care: barriers and facilitators of shared decision making in the context of decreasing the use of unnecessary antibiotics for preschool children ages 3-5 with upper respiratory tract infections

“…Seven articles were chosen to further examine facilitators of shared decision making (Brookes-Howell et al, 2014;Butler et al, 2012;Giguere et al, 2012;Hoye et al, 2010;Legare et al, 2013;Legare et al, 2012;Mangione-Smith et al, 2015). Giguere et al (2012) and Butler et al (2012) provided research on the effects of shared decision making education targeted towards PCPs on antibiotic prescribing trends.…”

“…Effective communication to facilitate shared decision making and reduce antibiotic use will be discussed by analysis of research by Mangione-Smith et al (2015) and Brookes-Howell et al (2014). Finally, research by Hoye, Frich and Lindboek (2010) that focused on delayed prescribing will be analyzed.…”

“…Mangione-Smith et al (2015) and Brookes-Howell et al (2012) found that parents were more likely to be satisfied with care when there was effective communication between PCPs and parents on diagnosis, treatment, and expected course of illness.…”

“…2014) is encouraged as a facilitator of shared decision making to avoid PCP misperception of parental requests (Mustafa et al, 2014). Adverse effects of antibiotics, lack of need for antibiotics for URIs, symptomatic relief of URIs, and the ineffectiveness of antibiotics against URIs are important messages to be communicated to parents during the shared decision making process, and are included in the GRIP URI framework (Atliner et al, 2014;Mangione-Smith et al, 2015).…”

“…Strategies to move forward without prescribing antibiotics were not provided in any of the literature reviewed. Although parents may request an antibiotic at the beginning of the consultation, a consensus evident in the literature was that improving the communication between PCPs and patients/parents will reduce requests for antibiotics for viral URIs at the end of a consultation, after shared decision making has occurred (Brookes-Howell et al, 2014;Butler et al, 2012;Giguere et al, 2012;Hoye et al, 2010;Legare et al, 2013;Legare et al, 2012;Mangione-Smith et al, 2015;Mustafa et al, 2014;Panagakou et al, 2012;van der Velden et al, 2013;& Yin et al, 2012). Parents who received non-antibiotic therapy suggestions as well as a follow up plan…”