title: Expectations for antibiotics increase their prescribing: Causal evidence about localized impact.
abstract: Clinically irrelevant but psychologically important factors such as patients' expectations for antibiotics encourage overprescribing. We aimed to (a) provide missing causal evidence of this effect, (b) identify whether the expectations distort the perceived probability of a bacterial infection either in a pre- or postdecisional distortions pathway, and (c) detect possible moderators of this effect.
  
  
  
  Family physicians expressed their willingness to prescribe antibiotics (Experiment 1, n₁ = 305) or their decision to prescribe (Experiment 2, n₂ = 131) and assessed the probability of a bacterial infection in hypothetical patients with infections either with low or high expectations for antibiotics. Response order of prescribing/probability was manipulated in Experiment 1.
  
  
  
  Overall, the expectations for antibiotics increased intention to prescribe (Experiment 1, F(1, 301) = 25.32, p < .001, ηp² = .08, regardless of the response order; Experiment 2, odds ratio [OR] = 2.31, and OR = 0.75, Vignettes 1 and 2, respectively). Expectations for antibiotics did not change the perceived probability of a bacterial infection (Experiment 1, F(1, 301) = 1.86, p = .173, ηp² = .01, regardless of the response order; Experiment 2, d = -0.03, and d = +0.25, Vignettes 1 and 2, respectively). Physicians' experience was positively associated with prescribing, but it did not moderate the expectations effect on prescribing.
  
  
  
  Patients' and their parents' expectations increase antibiotics prescribing, but their effect is localized-it does not leak into the perceived probability of a bacterial infection. Interventions reducing the overprescribing of antibiotics should target also psychological factors. (PsycINFO Database Record
authors.affiliation: Department of Psychology.
authors.forename: Miroslav
authors.identifier: 0000-0003-2117-9532
authors.initials: M
authors.lastname: Sirota
authors.affiliation: Primary Care and Public Health Sciences, King's College London.
authors.forename: Thomas
authors.initials: T
authors.lastname: Round
authors.affiliation: Department of Family Medicine, University of Sri Jayewardenepura.
authors.forename: Shyamalee
authors.initials: S
authors.lastname: Samaranayaka
authors.affiliation: Department of Surgery and Cancer, Imperial College London.
authors.forename: Olga
authors.initials: O
authors.lastname: Kostopoulou
mesh_terms: D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D000069342:Medical Overuse; D016017:Odds Ratio; D010290:Parents; D010361:Patients; D010821:Physicians, Family; D010818:Practice Patterns, Physicians'; D011336:Probability; D012141:Respiratory Tract Infections
chemical_list: D000900:Anti-Bacterial Agents