Avoiding Antibiotics: The Conversation That Works
More than 1100 child/parent dyads were included in the study, 78% of whom were white, 15% Asian, 3% black, and 7% of Hispanic ethnicity. It was a highly educated population, with 72% of the parents having at least a 4-year college degree. The mean age of the children was 4.2 years.
Only 5% of the visits resulted in an antibiotic prescription. In 48% of the visits, only positive treatment recommendations were given, followed by a combination of positive and negative treatment recommendations in 32% of the visits. Use of only negative treatment recommendations was uncommon at 6%. Contingency plans were provided at 23% of the visits.
In predictive models that adjusted for both provider and parent gender, age, race, ethnicity, education level, income level, and language, along with child demographic characteristics, the greatest reduction in the risk ratio for antibiotic prescribing occurred when both positive and negative treatment recommendations were provided. In those visits, the adjusted risk ratio for antibiotic prescribing was 0.15 (95% confidence interval, 0.06-0.40). This meant that the use of the combination technique was associated with an 85% reduction in the risk of prescribing an antibiotic at an ARTI visit.
The use of only negative treatment recommendations was not associated with a risk ratio. The use of only positive treatment recommendations was associated with a roughly 50% reduction in adjusted risk of prescribing an antibiotic. Provision of a contingency plan was also not associated with antibiotic prescribing risk.
When parental satisfaction was examined, only the use of both positive and negative treatment recommendations was associated with parent ratings of the visits, and the use of both techniques increased the chance that a visit would receive the highest score on patient satisfaction by 16%. No other communication technique was associated with the parental satisfaction score. Receipt of an antibiotic at the ARTI visit was also not associated with parental satisfaction.
The study authors concluded that use of both positive and negative treatment recommendations in visits for ARTI hold promise for reducing antibiotic prescribing while also improving patient satisfaction with the care delivered.
I am not sure what to add beyond what the authors concluded. Clearly, this study and others show that parents appreciate being able to do something for their child with an ARTI, and focusing on that positive message, alone or in combination with negative treatment recommendations, holds promise for improving antibiotic stewardship. It makes sense that using both positive and negative treatment recommendations might have the greatest effect on parental acceptance of not treating ARTI with antibiotics, and incorporation of both in postexamination discussions with parents is relatively easy to implement in practice.
This is an unusual study population, with high education levels and a relatively low prescribing frequency for ARTI, so it is easy to wonder whether the findings would hold true in different populations. However, the findings certainly have face validity, and a combined approach seems to be a safe way to proceed for now when evaluating children with ARTIs that do not require antibiotics.
Abstract
Study Findings
More than 1100 child/parent dyads were included in the study, 78% of whom were white, 15% Asian, 3% black, and 7% of Hispanic ethnicity. It was a highly educated population, with 72% of the parents having at least a 4-year college degree. The mean age of the children was 4.2 years.
Only 5% of the visits resulted in an antibiotic prescription. In 48% of the visits, only positive treatment recommendations were given, followed by a combination of positive and negative treatment recommendations in 32% of the visits. Use of only negative treatment recommendations was uncommon at 6%. Contingency plans were provided at 23% of the visits.
In predictive models that adjusted for both provider and parent gender, age, race, ethnicity, education level, income level, and language, along with child demographic characteristics, the greatest reduction in the risk ratio for antibiotic prescribing occurred when both positive and negative treatment recommendations were provided. In those visits, the adjusted risk ratio for antibiotic prescribing was 0.15 (95% confidence interval, 0.06-0.40). This meant that the use of the combination technique was associated with an 85% reduction in the risk of prescribing an antibiotic at an ARTI visit.
The use of only negative treatment recommendations was not associated with a risk ratio. The use of only positive treatment recommendations was associated with a roughly 50% reduction in adjusted risk of prescribing an antibiotic. Provision of a contingency plan was also not associated with antibiotic prescribing risk.
When parental satisfaction was examined, only the use of both positive and negative treatment recommendations was associated with parent ratings of the visits, and the use of both techniques increased the chance that a visit would receive the highest score on patient satisfaction by 16%. No other communication technique was associated with the parental satisfaction score. Receipt of an antibiotic at the ARTI visit was also not associated with parental satisfaction.
The study authors concluded that use of both positive and negative treatment recommendations in visits for ARTI hold promise for reducing antibiotic prescribing while also improving patient satisfaction with the care delivered.
Viewpoint
I am not sure what to add beyond what the authors concluded. Clearly, this study and others show that parents appreciate being able to do something for their child with an ARTI, and focusing on that positive message, alone or in combination with negative treatment recommendations, holds promise for improving antibiotic stewardship. It makes sense that using both positive and negative treatment recommendations might have the greatest effect on parental acceptance of not treating ARTI with antibiotics, and incorporation of both in postexamination discussions with parents is relatively easy to implement in practice.
This is an unusual study population, with high education levels and a relatively low prescribing frequency for ARTI, so it is easy to wonder whether the findings would hold true in different populations. However, the findings certainly have face validity, and a combined approach seems to be a safe way to proceed for now when evaluating children with ARTIs that do not require antibiotics.
Abstract
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