Parents, Physicians, and Antibiotic Use

Bauchner, Howard; Pelton, Stephen I.; Klein, Jerome O.

doi:10.1542/peds.103.2.395

Cited by 228 publications

(155 citation statements)

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“…Prior research suggests that a more informed public will make fewer demands for unnecessary antibiotics. [3][4][5] As a result, the Centers for Disease Control and Prevention (CDC), in collaboration with universities, pharmaceutical companies, health delivery systems, and other partners, developed the "Public Action Plan to Combat Antimicrobial Resistance." 6 As part of this effort, the CDC provides program support for several campaigns around the United States that are focusing on promoting appropriate antibiotic use.…”

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confidence: 99%

Racial/Ethnic Variation in Parent Expectations for Antibiotics: Implications for Public Health Campaigns

et al. 2004

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ABSTRACT. Context. Widespread overuse and inappropriate use of antibiotics are a major public health concern. Little is known about racial/ethnic differences in parents seeking antibiotics for their children's upper respiratory illnesses.Objective. To examine racial/ethnic differences in parent expectations about the need for antibiotics and physician perceptions of those expectations.Design. We conducted a nested, cross-sectional survey of parents who were coming to see their child's pediatrician because of cold symptoms between October 2000 and June 2001. Parents completed a previsit survey that collected information on demographics, their child's illness, and a 15-item previsit expectations inventory that included an item asking how necessary it was for the physician to prescribe antibiotics. Physicians completed a postvisit survey that collected information on diagnosis, treatment, and whether the physician perceived the parent expected an antibiotic. The encounter was the unit of analysis. Multivariate logistic regression analyses were performed to evaluate predictors of dichotomized parental expectations for antibiotics, dichotomized physician perceptions of those expectations, diagnostic patterns, and antibiotic-prescribing patterns.Setting. Twenty-seven community pediatric practices in the Los Angeles, Calif, metropolitan area.Participants. A volunteer sample of 38 pediatricians (participation rate: 64%) and a consecutive sample of 543 parents (participation rate: 83%; ϳ15 participating for each enrolled pediatrician) seeking care for their children's respiratory illnesses. Pediatricians were eligible to participate if they worked in a community-based managed care practice in the Los Angeles area. Parents were eligible to participate if they could speak and read English and presented to participating pediatricians with a child 6 months to 10 years old who had cold symptoms but had not received antibiotics within 2 weeks.Main Outcome Measures. Parental beliefs about the necessity of antibiotics for their child's illness, physician perceptions of parental expectations for antibiotics, bacterial diagnosis rates, and antibiotic-prescribing rates.Results. Forty-three percent of parents believed that antibiotics were definitely necessary, and 27% believed that they were probably necessary for their child's illness. Latino and Asian parents were both 17% more likely to report that antibiotics were either definitely or probably necessary than non-Hispanic white parents. Physicians correctly perceived that Asian parents expected antibiotics more often than non-Hispanic white parents but underestimated the greater expectations of Latino parents for antibiotics. Physicians also correctly perceived that parents of children with ear pain or who were very worried about their child's condition were significantly more likely to expect antibiotics. Physicians were 7% more likely to make a bacterial diagnosis and 21% more likely to prescribe antibiotics when they perceived that antibiotics were expected.Conclusions. Paren...

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Racial/Ethnic Variation in Parent Expectations for Antibiotics: Implications for Public Health Campaigns

et al. 2004

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“…In another study, when asked to identify the single most important program to reduce inappropriate antibiotic use in children, 78% of surveyed by guest on May 9, 2018 http://pediatrics.aappublications.org/ Downloaded from pediatricians indicated that educating parents about the judicious use of the antibiotics would be most efficacious. 18 We need effective techniques for educating parents about the judicious use of antibiotics. The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the American Society of Microbiology have developed an educational pamphlet entitled "Your Child and Antibiotics" for distribution in health care providers' offices.…”

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confidence: 99%

“…When pressured to prescribe these medications, 30% of pediatricians reported complying with this request "occasionally" or more frequently. 18 The effect of perception of parental expectations for antibiotics on physician behavior is striking. Mangione-Smith et al 19 found that private practice pediatricians prescribed antibiotics to 52% of children who were 2 to 10 years of age and presenting with URI symptoms and received a diagnosis of a viral illness when the physician reported that she or he perceived that the parent desired these medications versus 9% when he or she did not have this perception.…”

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Effectiveness of an Educational Intervention in Modifying Parental Attitudes About Antibiotic Usage in Children

Taylor

Kwan-Gett

McMahon³

2003

Pediatrics

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ABSTRACT. Objective. To determine the effectiveness of educational materials in improving the attitudes of parents of young children about the judicious use of antibiotics.Methods. We conducted a randomized controlled trial by recruiting parents of children who were younger than 24 months and being seen for any reason in primary care pediatric offices. At the time of enrollment, study parents indicated their level of agreement with 16 statements, including 9 statements about antibiotic usage and 7 about injury prevention. After being randomized, parents received either a pamphlet and a videotape promoting the judicious use of antibiotics (intervention group) or brochures about effective injury prevention (control group). Six weeks after enrollment, each group received another copy of the pamphlet or brochures and a follow-up questionnaire with the identical 16 statements. Responses on both questionnaires were transformed to an ordinal scale for analysis. Scores on the follow-up questionnaire for each statement about antibiotic use and injury prevention in the 2 groups were compared using linear regression, after controlling for the score obtained for the statement at enrollment.Results. We enrolled a total of 499 eligible parents in the study; 358 (72%) completed the follow-up questionnaires. At study entry, there were no significant differences between parents in the intervention and control groups regarding attitudes for 15 of the 16 statements assessed. However, 6 weeks after receiving the antibiotic educational materials, parents in the intervention group had significantly different attitude scores for 5 of the 9 statements about the antibiotic use. In each case, the scores reflected attitudes that would promote the judicious use of antibiotics. We found significant attitudinal change for statements about the use of antibiotics for specific conditions in children; there were no differences between the 2 groups for more general or theoretical statements about antibiotic use.Conclusions. A simple educational effort was successful in modifying parental attitudes about the judicious use of antibiotics. Information about specific childhood conditions may be more effective in changing attitudes than more general information about antibiotic usage. T he emergence of antibiotic-resistant bacterial pathogens, particularly drug-resistant Streptococcus pneumoniae (DRSP), is cause for serious and growing concern. 1-5 Although the emergence of DRSP 6 -8 is probably multifactorial, recent evidence suggests that the injudicious use of antibiotics is partly responsible for the increasing prevalence of these bacterial strains. 2,9,10 Curbing this excessive use of antibiotics will be an important part of any effort designed to reduce the prevalence of DRSP.In an attempt to decrease the overuse of antibiotics in children, practice guidelines for the appropriate use of these medications in the management of otitis media, sinusitis, and upper respiratory tract infections (URIs) have been published. [11][12][13][14][15] Other met...

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“…Other studies included educational interventions for both parents and physicians had promising results. [17][18] However, only a few studies assessed the changes with regard to specific diagnoses, as was done in this study. Smabrekke et al 19 noted a reduction in antibiotic prescriptions for AOM, from 90% to 74%, and also a reduction in broad-spectrum antibiotic use, after an educational intervention addressing physicians and parents.…”

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confidence: 99%

Optimizing Clinical Diagnosis and Antibiotic Prescribing for Common Respiratory Tract Infections, Fanara Family Health Center- Rural Egypt

2018

The Egypt. J. of Community Medicine

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Background: Antibiotic prescribing for respiratory tract infections (RTI) by primary care doctors has received renewed interest due to the continuing emergence of antibiotic resistance, increased incidence of adverse effects and the attendant cost to healthcare especially in developing countries like Egypt. Despite the majority of these infections being viral it seems that many determinants other than the etiology are the main factors that influence a high rate of prescribing antibiotic for these self-limiting infections. Objective: We aimed to assess the impact of a physician-based educational intervention to improve clinical diagnosis of bacterial causes of RTIs and reduce unnecessary antibiotic prescription for these infections. Methods: This is a clinical trial, where 11 family medicine residents working at a rural family health center in Egypt participated in an educational program to improve their antibiotic prescribing skills when treating common RTI. Their patterns of prescribing antibiotic have been studied among all patients 3 months old or above who attended the family center with RTI, for 2 months before and after the educational intervention (1 st of December 2015 to 10 th of March 2016). The educational intervention comprised 4 hours, 2 lectures and another 4 hours, 2 small group discussions in updated management of RTI and health education principles based mainly on NICE guidelines and Health Belief Model (HBM) respectively. The primary outcome was measuring the impact of the educational intervention on rates of prescribing antibiotic for 4 RTI [Acute otitis media (AOM), tonsillopharyngitis, rhino sinusitis and acute bronchitis], the appropriateness of using clinical diagnostic criteria of bacterial causes of these infections and the appropriate selection of antibiotic when its use was justified. Results: The overall antibiotic prescription was significantly reduced (8.3%) from base line ( 80.3%( to post intervention (72%) period, (P=0.007). This reduction was significant for both tonsillopharyngitis (12.2%, P=0.019) and otitis media (14.2%, P= 0.033). There were also significant improvement in using clinical diagnostic criteria for bacterial causes of the four studied RTI with 12.5% overall improvement (P=0.001). There was also improvement in the overall appropriateness of selecting first line antibiotic when its use was justified this improvement was achieved for both tonsillopharyngitis (17.8%, P= 0.004) and AOM (P= <0.001). Conclusion: Clinical diagnosis of bacterial causes of common RTIs and appropriate antibiotic use for these infections can be improved in primary health care settings using a physician based educational program.

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Parents, Physicians, and Antibiotic Use

Abstract: Pediatricians acknowledge prescribing antimicrobial agents when they are not indicated. Pediatricians believe educating parents is necessary to promote the judicious use of antimicrobial agents.

Cited by 228 publications

References 20 publications

Racial/Ethnic Variation in Parent Expectations for Antibiotics: Implications for Public Health Campaigns

Racial/Ethnic Variation in Parent Expectations for Antibiotics: Implications for Public Health Campaigns

Effectiveness of an Educational Intervention in Modifying Parental Attitudes About Antibiotic Usage in Children

Optimizing Clinical Diagnosis and Antibiotic Prescribing for Common Respiratory Tract Infections, Fanara Family Health Center- Rural Egypt

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