Association between parental satisfaction and antibiotic prescription for children with cough and cold symptoms.
BACKGROUND
Providers' interest in satisfying parents may provide an impetus for unnecessary antibiotic use in children.


OBJECTIVE
To determine (1) whether receipt of antibiotics at a visit for cough and cold symptoms was associated with increased satisfaction and (2) whether nonreceipt of antibiotics at an initial visit but subsequent receipt of antibiotics in the course of the same illness episode was associated with decreased satisfaction.


METHODS
Prospective cohort study of patients 2-10 years of age presenting to a university-affiliated pediatric clinic with cough and cold symptoms. Parents were enrolled at the index visit and then followed up by phone at least 7 days later (mean time to follow-up, 14.9 days). Satisfaction with the index visit on a 10 point scale was the primary outcome. The primary predictors were whether antibiotics were prescribed at the index visit and, if not, whether they were prescribed since that visit. Linear and median regression were used to adjust for income, child age, parental race and individual provider.


RESULTS
A total of 539 parents were enrolled in the study, and 378 (70%) completed follow-up interviews. The mean age of participating children was 4.67 years (SD 2.16). Overall 47% of patients received antibiotics at the index visit, and 8% of those that did not reported receiving them between the index visit and the follow-up assessment. In the regression model, receiving antibiotics at the index visit trended toward being associated with higher satisfactions scores (0.28; P = 0.08). Among those who did not receive antibiotics initially, receiving them subsequently was associated with significantly lower median satisfaction score for the index visit (-3.0; P < 0.01).


CONCLUSIONS
Receiving antibiotics after an initial visit for cough and cold symptoms at which antibiotics were not prescribed is associated with decreased satisfaction. Use of contingency prescriptions may be an important intervention.
Christakis
Dimitri A
DA
Children's Hospital and Regional Medical Center, University of Washington, Seattle, WA, USA. dachris@u.washington.edu
Wright
Jeffrey A
JA
Taylor
James A
JA
Zimmerman
Frederick J
FJ
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003371:Cough / Q000175:diagnosis / Q000188:drug therapy; D004363:Drug Utilization; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D010290:Parents; D010549:Personal Satisfaction; D010818:Practice Patterns, Physicians'; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000188:drug therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States
D000900:Anti-Bacterial Agents