Ruling out the need for antibiotics: are we sending the right message?
OBJECTIVE
To examine the relationships among physician-parent communication practices, physicians' perceptions of parental expectations for antibiotic treatment, and inappropriate antibiotic prescribing for viral upper respiratory tract infections.


METHODS
Cross-sectional study of pediatric encounters motivated by cold symptoms between October 1, 2000, and June 30, 2001. Each encounter was videotaped. Physicians completed a postvisit survey that measured whether they perceived the parent as expecting antibiotics. Coded communication variables were merged with survey variables. Multivariate analyses identified key predictors of parent-physician communication practices, physician perceptions of parents' expectations for antibiotics, and inappropriate antibiotic prescribing for viral conditions.


METHODS
Twenty-seven pediatric practices in Los Angeles, Calif.


METHODS
Thirty-eight pediatricians and 522 consecutively approached parents of children with cold symptoms.


METHODS
Physicians' perceptions of parental expectations for antibiotics, inappropriate antibiotic prescribing, and parental questioning of nonantibiotic treatments.


RESULTS
Physicians were 20.2% more likely to perceive parents as expecting antibiotics when they questioned the physician's treatment plan (P = .004; 95% confidence interval, 6.3%-34.0%). When physicians perceived parents as expecting antibiotics, they were 31.7% more likely to inappropriately prescribe them (P<.001; 95% confidence interval, 16.0%-47.3%). Parents were 24.0% more likely to question the treatment plan when the physician ruled out the need for antibiotics (P = .004; 95% confidence interval, 7.7%-40.3%).


CONCLUSIONS
Parental questioning of the treatment plan increases physicians' perceptions that antibiotics are expected and thus increases inappropriate antibiotic prescribing. Treatment plans that focus on what can be done to make a child feel better, rather than on what is not needed, ie, antibiotics, may decrease inappropriate antibiotic prescribing.
Mangione-Smith
Rita
R
Department of Pediatrics, University of California-Los Angeles, Calif, USA. ritams@u.washington.edu
Elliott
Marc N
MN
Stivers
Tanya
T
McDonald
Laurie L
LL
Heritage
John
J
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001294:Attitude to Health; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D015141:Los Angeles; D008297:Male; D010290:Parents / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011368:Professional-Family Relations; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000821:virology*; D014743:Videotape Recording
D000900:Anti-Bacterial Agents