Article Figures & Data
Figures
- Figure 1
Percentages of parents giving various responses to statements about antibiotic use.
AOM = acute otitis media.
Tables
Characteristic Parents, No. (%) General Public, %a Female 309 (77) 51 Age-group, y ≤25 5 (1) 14 26–35 84 (21) 18 36–45 248 (62) 19 46–55 59 (15) 18 ≥56 5 (1) 32 Born in Australia 309 (77) – English spoken as main language at home 380 (95) – Aboriginal or Torres Strait Islander 7 (2) 3 Current living situation Married or living with partner 355 (89) – Sole caregiving responsibility 39 (10) – Other 7 (2) – Highest level of education Primary school 1 (0) 5 Junior high school 15 (4) 17 Senior high school 50 (13) 38 Trade or apprenticeship 31 (8) – Diploma or certificate 103 (26) 21 Bachelor’s degree 133 (33) 11 Post-graduate degree 68 (17) 4 Employment status Full time (>30 h/wk) 146 (36) – Part time (<30 h/wk) 139 (35) – Casual employment 29 (7) – Not currently in paid employment 86 (21) 5.7 Number of children ≤12 years, mean (SD) [range] 2 (0.85)
[1–6]– Annual gross household income, $b <20,000 11 (3) – 20,001–40,000 24 (6) – 40,001–60,000 34 (9) – 60,001–80,000 44 (11) – 80,001–100,000 63 (16) – 100,001–140,000 115 (29) – 140,001–180,000 52 (13) – >180,000 33 (8) – Health Care Card holderc 72 (18) – Time since most recent visit to doctor for child with AOM, sore throat, or acute cough, median (IQR), wk 43
(9–104)– Age of child at last visit, median (IQR), y 6 (3–8) – Illness Type Parent-Estimated Benefit, Mean (SD) [Range], Days Actual Benefit, Based on Empirical Evidence, Mean, Days Reduction in Illness Duration From Antibiotics Minimum Reduction in Duration Before Antibiotics Considered Worth Using Acute otitis media 3.0 (1.4) [0–7.0] 3.0 (1.5) [0–7.0] 0.55 Sore throat 2.6 (1.4) [0–7.0] 2.7 (1.6) [0–7.0] 0.57 Acute cough 5.4 (3.1) [0–14.0] 5.0 (3.0) [0–14.0] <0.56 - Table 3
Parents’ Recall of the Last Visit With Their Child to a Doctor for an Acute Respiratory Infection
Question Parents Giving Response, % A Lot Some A Little Not at All Were reasons you might want an antibiotic for your child discussed with the doctor? 18 26 32 24 Were reasons you might not want to use an antibiotic discussed with the doctor? 12 15 24 48 Would you prefer involvement in future decisions about the use of antibiotics for acute respiratory infections for your child? 75 18 5 2 Parents Responding “No,” % Was there any discussion about possible harms of antibiotics? 78 Were you asked by the doctor whether or not you wanted an antibiotic for your child? 61 Did the doctor explain that you had a choice about whether or not an antibiotic was prescribed? 61 Was the decision about antibiotic prescribing shared between you and your doctor? 56
Supplemental Figures 1-2 & Supplemental Tables 1-6
Supplemental Figures 1-2 & Supplemental Tables 1-6
Files in this Data Supplement:
- Supplemental Data: Figures 1-2 & Tables 1-6 - PDF file
The Article in Brief
Parents' Expectations and Experiences of Antibiotics for Acute Respiratory Infections in Primary Care
Tammy C. Hoffmann , and colleagues
Background Antibiotics are too often prescribed for acute respiratory infections, despite strong evidence they typically provide only marginal benefit. This study explores parents' expectations and experiences using antibiotics for pediatric respiratory infections.
What This Study Found Most parents believe antibiotics provide benefits for common acute respiratory infections, particularly acute otitis media, although not using them, particularly for acute cough and sore throat, is sometimes acceptable. Parents grossly overestimate the benefit of antibiotics in reducing the duration of illness by five to 10 times, and many believe they reduce the likelihood of complications, especially for otitis media. The large majority recognize antibiotics may do harm, although there is confusion among many about what resistance actually is. Fewer than one-half of those interviewed recall discussing benefits and harms and the option of forgoing antibiotic use with their clinician, and 75 percent would like more involvement in future decisions.
Implications
- The authors suggest adopting shared decision making to address overly optimistic expectations of antibiotics and antibiotic harms.
Annals Journal Club
Mar/Apr 2017: What Parents Believe about Antibiotics
The Annals of Family Medicine encourages readers to develop a learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club. RADICAL is an acronym for Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. "Radical" also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care and acting on those discussions.1
HOW IT WORKS
In each issue, the Annals selects an article and provides discussion tips and questions. We encourage you to take a RADICAL approach to these materials and post a summary of your conversation in our online discussion. (Open the article online and click on "TRACK Discussion: Submit a comment.") Details are available at http://www.AnnFamMed.org/site/AJC/.
CURRENT SELECTION
Article for Discussion
Coexter PD, Del Mar C, Hoffman TC. Parents' expectations and experiences of antibiotics for acute respiratory infections in primary care. Ann Fam Med 2017;15(2):149-154.
Discussion Tips
Surveys are an important tool that can help researchers explain phenomena as well as gain a better grasp on current practice. This survey investigates parents' perceptions about treatment of acute respiratory tract infections that could increase our knowledge about tackling the challenging problem of antibiotic overuse in children.
Discussion Questions
- What question is asked by this study and why does it matter?
- How does this study advance beyond previous research and clinical practice on this topic?
- How strong is the study design for answering the question? How does the response rate affect your interpretation of the validity of the findings?
- How were individuals selected or excluded to participate? How could this have introduced bias into the study?
- What are the main study findings?
- The authors asked about cough, sore throat, and acute otitis media. What do you think about the differences in the responses between the 3 conditions?
- Do you feel the individuals that were surveyed were similar to the parents in your practice?
- A large majority of parents endorsed a desire to have a say in their children's treatment. Despite this, parents reported a much lower rate of shared decision making. Do think this is consistent with practice in your clinic?
- How could you increase the use of shared decision making in your practice? How might this article and other articles inform you about how to approach this?2-3
- In what other ways might this study change your practice? Policy?
- What researchable questions remain?
References
- Stange KC, Miller WL, McLellan LA, et al. Annals Journal Club: It's time to get RADICAL. Ann Fam Med. 2006;4(3):196-197 http://annfammed.org/content/4/3/196.full.
- Coexter PD, Del Mar C, Hoffman TC. Parents' expectations and experiences of antibiotics for acute respiratory infections in primary care. Ann Fam Med 2017;15(2):149-154.
- Riggs KR, Ubel PA, Saloner B. Can appealing to patient altruism reduce overuse of health care services? An experimental survey. J Gen Intern Med. 2017 Feb 2. Epub ahead of print.
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- What Parents Believe about Antibiotics
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