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Research ArticleOriginal Research

Communication Practices and Antibiotic Use for Acute Respiratory Tract Infections in Children

Rita Mangione-Smith, Chuan Zhou, Jeffrey D. Robinson, James A. Taylor, Marc N. Elliott and John Heritage
The Annals of Family Medicine May 2015, 13 (3) 221-227; DOI: https://doi.org/10.1370/afm.1785
Rita Mangione-Smith
1Department of Pediatrics, University of Washington, Seattle, Washington
2Seattle Children’s Research Institute, Seattle, Washington
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  • For correspondence: Rita.Mangione-Smith@seattlechildrens.org
Chuan Zhou
1Department of Pediatrics, University of Washington, Seattle, Washington
2Seattle Children’s Research Institute, Seattle, Washington
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Jeffrey D. Robinson
3Department of Communication, Portland State University, Portland, Oregon
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James A. Taylor
1Department of Pediatrics, University of Washington, Seattle, Washington
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Marc N. Elliott
4RAND Corporation, Santa Monica, California
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John Heritage
5Department of Sociology, University of California, Los Angeles, Los Angeles, California
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Abstract

PURPOSE 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).

CONCLUSION 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.

  • physician-patient communications
  • acute respiratory tract infections
  • antibiotic prescribing
  • patient satisfaction
  • visit ratings
  • Received for publication November 26, 2014.
  • Revision received February 21, 2015.
  • Accepted for publication March 4, 2015.
  • © 2015 Annals of Family Medicine, Inc.
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The Annals of Family Medicine: 13 (3)
The Annals of Family Medicine
Vol. 13, Issue 3
May/June 2015
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Communication Practices and Antibiotic Use for Acute Respiratory Tract Infections in Children
Rita Mangione-Smith, Chuan Zhou, Jeffrey D. Robinson, James A. Taylor, Marc N. Elliott, John Heritage
The Annals of Family Medicine May 2015, 13 (3) 221-227; DOI: 10.1370/afm.1785

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Communication Practices and Antibiotic Use for Acute Respiratory Tract Infections in Children
Rita Mangione-Smith, Chuan Zhou, Jeffrey D. Robinson, James A. Taylor, Marc N. Elliott, John Heritage
The Annals of Family Medicine May 2015, 13 (3) 221-227; DOI: 10.1370/afm.1785
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Subjects

  • Domains of illness & health:
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  • Person groups:
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