Communication practices and antibiotic use for acute respiratory tract infections in children
Rita Mangione-Smith1, Chuan Zhou2, Jeffrey D Robinson3
1Department of Pediatrics, University of Washington, Seattle, Washington Seattle Children's Research Institute, Seattle, Washington Rita.Mangione-Smith@seattlechildrens.org.
Insights
Provider communication strategies can reduce antibiotic prescribing for pediatric acute respiratory tract infections (ARTI) and improve parent satisfaction. Explaining treatment options and ruling out antibiotic necessity enhances care ratings.
Area of Science:
- Pediatric healthcare
- Infectious disease management
- Health communication
Background:
- Antibiotic resistance is a significant public health threat.
- Appropriate antibiotic prescribing for acute respiratory tract infections (ARTI) in children is crucial.
- Parental expectations and satisfaction influence healthcare interactions.
Purpose of the Study:
- To investigate the association between provider communication practices and antibiotic prescribing for pediatric ARTI.
- To examine the relationship between communication strategies and parent satisfaction with pediatric visits.
- To identify communication techniques that may mitigate antibiotic overuse and improve care ratings.
Main Methods:
- Cross-sectional study of 1,285 pediatric visits for ARTI symptoms.
- Data collected via provider and parent post-visit surveys.
- Multivariate analyses used to determine predictors of antibiotic prescribing and parent visit ratings.
Main Results:
- Suggesting positive treatment recommendations (actions parents can take) was associated with decreased antibiotic prescribing (aRR 0.48).
- Combining positive and negative treatment recommendations (ruling out antibiotics) further reduced prescribing risk (aRR 0.15).
- Parents receiving combined recommendations were more likely to provide the highest visit rating (aRR 1.16).
Conclusions:
- Combined positive and negative treatment recommendations may decrease unnecessary antibiotic prescribing for viral ARTIs.
- These communication strategies can simultaneously enhance parent visit ratings.
- Implementing these techniques can aid frontline providers in combating antibiotic resistance.
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.
Results:
Suggesting 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.
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