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Parent Expectations for Antibiotics, Physician-Parent Communication, and Satisfaction
Rita Mangione-Smith, MD, MPH;
Elizabeth A. McGlynn, PhD;
Marc N. Elliott, PhD;
Laurie McDonald, MS;
Carol E. Franz, PhD;
Richard L. Kravitz, MD, MSPH
Arch Pediatr Adolesc Med. 2001;155:800-806.
Objectives To explore how parents communicate their preferences for antibiotics
to their child's physician and to examine whether physicians can communicate
why antibiotics are not being prescribed in a way that maintains satisfaction
with the visit.
Design Previsit survey of parents, audiotaping of the study encounters, and
a postvisit survey of parents and physicians.
Setting Two private pediatric practices.
Participants Ten physicians (response rate = 77%) and a consecutive sample of 295
eligible parents (response rate = 86%) who attended acute care visits for
their children between October 1996 and March 1997.
Main Outcome Measures Physician-perceived pressure to prescribe antibiotics and parental visit-specific
satisfaction.
Results Fifty percent of parents expressed a previsit expectation for antibiotics.
Among these parents, only 1% made a direct verbal request for them. Even when
no direct requests for antibiotics were made, physicians still perceived an
expectation for antibiotics 34% of the time. Among parents who did not receive
expected antibiotics, those offered a contingency plan from the physician
(ie, the possibility of receiving antibiotics in the future if their child
did not get better) had a higher mean satisfaction score than parents not
receiving a contingency plan (76 vs 58.9; P<.05).
Conclusion Physicians should consider providing a contingency plan to parents who
expect antibiotics for their children when there is no clinical indication.
Further study is needed to determine how parents indirectly communicate their
desire for antibiotics and what additional communication techniques physicians
can use to resist the overprescribing of antibiotics.
From the Department of Pediatrics, University of California, Los Angeles
(Dr Mangione-Smith); RAND, Santa Monica, Calif (Drs McGlynn, Elliott, and
McDonald); and the Center for Health Services Research in Primary Care, University
of California, Davis (Drs Franz and Kravitz).
Corresponding author and reprints: Rita Mangione-Smith, MD, MPH,
UCLA Department of Pediatrics, 12-365 Marion Davies Children's Center, 10833
LeConte Ave, Los Angeles, CA 90095-1752 (e-mail: ritams{at}ucla.edu).
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