title: Communication practices and antibiotic use for acute respiratory tract infections in children.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, Washington Seattle Children's Research Institute, Seattle, Washington Rita.Mangione-Smith@seattlechildrens.org.
authors.forename: Rita
authors.initials: R
authors.lastname: Mangione-Smith
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, Washington Seattle Children's Research Institute, Seattle, Washington.
authors.forename: Chuan
authors.initials: C
authors.lastname: Zhou
authors.affiliation: Department of Communication, Portland State University, Portland, Oregon.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Robinson
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, Washington.
authors.forename: James A
authors.initials: JA
authors.lastname: Taylor
authors.affiliation: RAND Corporation, Santa Monica, California.
authors.forename: Marc N
authors.initials: MN
authors.lastname: Elliott
authors.affiliation: Department of Sociology, University of California, Los Angeles, Los Angeles, California.
authors.forename: John
authors.initials: J
authors.lastname: Heritage
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D014861:Washington
chemical_list: D000900:Anti-Bacterial Agents
keywords: acute respiratory tract infections; antibiotic prescribing; patient satisfaction; physician-patient communications; visit ratings