The findings, being presented May 6 at the Pediatric Academic Societies annual meeting in Baltimore, Md., also show that despite current educational efforts, physicians continue to prescribe antibiotics if they feel pressure from parents.
“We know that patients with respiratory illnesses receive antibiotics 30 percent of the time. However, 55 percent of antibiotic prescriptions for these illnesses are not needed. There have been several nationwide health campaigns to educate people that antibiotics are not necessary for treating the common cold and that inappropriate use can lead to antibiotic-resistant infections,” said Dr. Rita Mangione-Smith, lead investigator and pediatrician at Mattel Children’s Hospital at UCLA. “We wanted to find out which groups of parents were not getting this message so that educational efforts could be made more effective.”
To conduct the study, researchers surveyed 570 Los Angeles-area parents who visited the doctor’s office because of their child’s respiratory illness from October 2000 to June 2001. Thirty-eight physicians were enrolled at 27 sites. Parents completed a pre-visit survey that gathered information on demographics and their child’s illness, and included a 15-item “expectation” inventory to find out how necessary the parent believed it was for the doctor to prescribe antibiotics. Doctors then completed a post-visit survey to determine diagnosis, treatment and whether or not they believed the parent expected antibiotics.
Among the findings:
- Seventy percent of parents believed that antibiotics were either definitely or probably necessary for their child’s illness.
- Among physicians, only 36 percent reported that they either strongly or somewhat agreed that the parent had come into the visit expecting to receive antibiotics.
- Latino parents were 2.5 times more likely than white parents to expect antibiotics, while Asian parents were 3.5 times more likely than whites to expect antibiotics.
- While physicians correctly perceived that Asian parents expected antibiotics more often than whites, they underestimated expectations of Latino parents.
- Doctors correctly perceived that parents of children with ear pain, or those parents who were very worried about their child’s condition, were significantly more likely to expect antibiotics.
- Doctors prescribed antibiotics 65 percent of the time if they perceived that parents expected them, 47 percent of the time if they were uncertain and only 12 percent of the time if they perceived parents did not expect them.
“Our results suggest that public health campaigns to date have not been culturally appropriate for Asian and Latino parents,” Mangione-Smith said. “We also learned that if doctors sense that parents expect antibiotics, they are 22 percent more likely to prescribe them regardless of what the physical examination shows. This may represent an attempt to keep parents who are perceived as wanting antibiotics satisfied.
“However, our previous work has shown that receiving expected antibiotics does not increase parent satisfaction with the visit — what does help satisfaction levels is good communication between the doctor and parent,” she said. “To help decrease over-prescribing of antibiotics for colds, our future research efforts will need to examine both the cultural beliefs of Asians and Latinos and how doctors and parents can better communicate.”
The research was funded by a grant from the Robert Wood Johnson Foundation of Princeton, N.J.
Mattel Children’s Hospital at UCLA offers a full spectrum of primary and specialized medical care for infants, children and adolescents. Its mission is to provide treatment for children in a compassionate atmosphere, as well as to conduct research that improves the understanding and treatment of pediatric cases. For more information, please visit our Web site at www.pediatrics.medsch.ucla.edu.