The Relationship Between Perceived Parental Expectations and Pediatrician Antimicrobial Prescribing Behavior

Abstract

The antibiotic resistance epidemic should lead to immediate replication of this study in a larger more generalizable population. If inaccurate physician perceptions of parent desires for antimicrobials for viral infections are confirmed, then an intervention to change the way physicians acquire this set of perceptions should be undertaken.

Online commentary during the physical examination: a communication tool for avoiding inappropriate antibiotic prescribing?

“…They were correct about parental expectations 73% of the time when parents did not expect antibiotics and 41% of the time when parents expected antibiotics. This degree of agreement is just slightly better than chance (Po0:05; kappa=0.14) (Mangione-Smith et al, 1999).…”

“…In a previous analysis of these data, we found that physicians prescribed antibiotics for presumed viral illnesses 62% of the time when they thought parents expected antibiotics versus 7% of the time when they did not think that antibiotics were desired (Mangione-Smith et al, 1999). In a survey conducted by the Centers for Disease Control and Prevention, 58% of the physicians similarly reported their decisions to prescribe antibiotics for children with upper respiratory infections were influenced by parental pressure (Watson et al, 1999).…”

“…Parents who participated were older (mean=38 yr), highly educated (mean=16 yr), and had high incomes (75% had annual incomes greater than $50,000). Non-whites comprised one-third of the sample, and 60% were enrolled in managed care plans (Mangione-Smith et al, 1999).…”

“…The study design and survey data collection methods have been described in detail elsewhere (Mangione-Smith et al, 1999). Briefly, parents completed a 15-item pre-visit expectations inventory which included one item about whether they thought it was necessary for the physician to prescribe antibiotics.…”

“…Efforts to reduce inappropriate antibiotic prescribing have generally focused on educating physicians. However, there are many instances where the physician is aware of the problems related to appropriateness, safety, efficacy, and cost but these factors are outweighed by others such as perceived patient/parental expectations or lack of time to negotiate a different management plan (Mangione-Smith, McGlynn, Elliott, Krogstad, & Brook, 1999;Butler, Rollnick, Pill, Maggs-Rapport, & Stott, 1998). Intervention trials that do not take these other issues into account are likely to fail in changing prescribing behavior.…”