Elsevier

Social Science & Medicine

Volume 58, Issue 3, February 2004, Pages 623-629
Social Science & Medicine

Knowledge and beliefs of primary care physicians, pharmacists, and parents on antibiotic use for the pediatric common cold

https://doi.org/10.1016/S0277-9536(03)00231-4Get rights and content

Abstract

The aim of this study is to investigate knowledge and beliefs of primary care physicians (e.g. family practitioners and pediatricians), pharmacists, and parents regarding the use of antibiotics for the pediatric common cold, using a self-administered questionnaire for physicians and pharmacists and a telephone interview for parents. This article suggests that parents’ expectation for antibiotics is a minor factor, and health care providers’ unfounded beliefs in the effectiveness of antibiotics and exaggeration of parents’ demand for antibiotics may be the major contributing factor underlying antibiotic over-prescription for the pediatric common cold in Korea. Most physicians and pharmacists knew the correct cause of the pediatric common cold, but majorities of the physicians and pharmacists believed that antibiotics could treat and reduce its complications. On the other hand, 34% of the parents believed that antibiotics could prevent complications. Seventy three per cent of the physicians reported that they perceived expectations for antibiotics from parents, but only 2% of the parents reported asking their physicians for antibiotics. In summary, this study suggests that physicians’ knowledge and faulty beliefs can be more important factors for inappropriate antibiotic prescription.

Introduction

Korea has had compulsory medical insurance with universal coverage of the population since 1989. People freely choose among family physicians, specialists, and even outpatient departments of hospitals. All medical services are reimbursed on a fee-for-service basis and patients pay a small amount out-of-pocket (about 3 US Dollars) when they visit a clinic. Korea introduced a policy to segregate the roles of physicians and pharmacists in July 2000. Before that time, pharmacists could dispense medicine, including antibiotics without physician prescription.

The pediatric common cold is a leading cause of office visits to physicians in Korea (National Health Insurance Corporation, 2001). Antimicrobial resistance is a major public health issue, in that 86% of Streptococcus pneumoniae is now resistant to penicillin in Korea (Lee et al., 2001). The antibiotic prescription rate for the pediatric common cold is 90.6%, based on insurance claim data in Korea (Park & Moon, 1998), which is much higher than that of other countries. The relevant antibiotic prescription rate is 44% in the USA (Nyquist, Gonzales, Steiner, & Sande, 1998) and 17% in the Netherlands for encounters with the acute upper respiratory infection (de Melke & Kuyvenhoven, 1994). As there is clear evidence that the increased resistance is associated with recent antibiotic overuse (Arason et al., 1996), this overuse should be reduced to a minimum.

Several factors have been suggested as associated with the prescription of antibiotics for the common cold. Palmer summarized these as parental demand, time constraints, and concerns about malpractice and litigation (Palmer & Baucher, 1997). In addition, she thought the physician’s perception of patient expectations is a much more important predictor than patient expectation itself, though one study suggested that these perceptions are the only significant predictor of prescribing antibiotic for viral illness (Mangione-Smith, McGlynn, Elliot, Krogstad, & Brook, 1999). When physicians are pressured to see many patients, writing a prescription is perceived as more time-efficient than explaining the natural course of an upper respiratory infection (Schwartz, Mainous, & Marcy, 1998). Concern for malpractice and litigation may also be associated with antibiotic prescription.

As the antibiotic prescription rate for the pediatric common cold in Korea is much higher than in other countries (Kim et al., 2000), there may be more specific or stronger factors in Korea. Parental demand for antibiotics may not be the most important factor, since the power relationship between physicians and parents is not equal. The fact that, in Korea, only one quarter of parents have been reported as being have given an explanation about disease by their physicians, and approximately 20% of parents have reported questioning the doctor about whether the prescription contained antibiotics or not (Park, Kim, Kim, & Kim, 2001), suggests imbalance in power between physicians and parents. In addition, physicians’ level of knowledge is one of the most important reasons for inappropriate prescribing (Lexchin, 1998), and the knowledge and beliefs of Korean health care providers about antibiotics may be different from those in other countries.

Korea introduced a policy of segregating the role of physicians and pharmacists in July 2000. Before the policy was introduced, pharmacists could dispense antibiotics without a physicians’ prescription, creating competition between physicians and pharmacists in addition to competition among physicians themselves. As Korea does not have a registration system similar to general practise in the UK, and only half of patients have a regular source of care (Cho, Shim, Lee, & Lee, 2001), patients choose physicians freely. “Doctor shopping” is very prevalent and competition among physicians is strong. Despite pharmacists’ loss of discretionary power to prescribe antibiotics, they still maintain a strong influence on antibiotic use due to their accessibility to patients.

The objectives of this study are to compare the knowledge and beliefs of primary care physicians, pharmacists, and parents concerning the effect of antibiotics on the pediatric common cold, and to investigate the possible factors related to the high antibiotic prescription rate for the pediatric common cold in Korea. Because to survey patients who visited doctors’ offices might bias the result, it was necessary to base our study on a sample of the general population.

Section snippets

Methods

A simple random sample of 600 physicians (300 from each specialty) was taken from the Health Insurance Corporation Health Care Organization file, containing 1995 family physicians and 2857 pediatricians who were working in clinic. Sample size was decided by a power calculation on the categorical variables, 5% significance level. This indicated a minimum of 152 physicians in each group, with a response rate of 70%. It was decided to start with samples of 300 physicians in each group.

The

Results

The demographic characteristics of the study subjects are shown in Table 1, Table 2. Most primary care physicians were male, practising solo in urban areas, and saw approximately 80 patients in a usual day. Compared with the physicians, the majority of the pharmacists were female. They worked more often in a group, worked predominantly in urban areas, and dispensed more than 100 prescriptions a day. Almost all responding parents were female, living in urban area and about half of them visited a

Discussion

This is the first report to compare the knowledge and beliefs of physicians, pharmacists, and parents on antibiotic use for the pediatric common cold. We tried to obtain representative samples of primary care physicians, pharmacists, and parents and to obtain a good response rate to assure the validity of the study. Responding parents were predominantly female, but the usual caregivers in Korea are women.

Knowledge and beliefs of physicians and pharmacists in Korea are very different from those

Acknowledgements

I would like to thank Dr. Jee-Young Pak, Dr. Anita K. Wagner and Dr. Lisa Pfeiffer for revising English on an earlier version of this paper.

References (35)

  • H.-J Cho et al.

    Factors associated with possession of regular doctor in Korea

    Journal of Korean Academy of Family Medicine

    (2001)
  • J Cockburn et al.

    Prescribing behaviour in clinical practice: Patients’ expectations and doctors’ perceptions of patients’ expectationsA questionnaire study

    British Medical Journal

    (1997)
  • C.A Collett et al.

    Parents knowledge about common respiratory infections and antibiotic therapy in children

    Southern Medical Journal

    (1999)
  • R.A de Melke et al.

    Management of upper respiratory tract infections in Dutch family practice

    Journal of Family Practice

    (1994)
  • A.M Gadomski

    Potential interventions for preventing pneumonia among young childrenLack of effect of antibiotic treatment for upper respiratory infections

    Pediatric Infectious Disease Journal

    (1993)
  • R Gonzales et al.

    Impact of reducing antibiotic prescribing for acute bronchitis on patient satisfaction

    Effective Clinical Practice

    (2001)
  • R.M Hamm et al.

    Antibiotics and respiratory infectionsAre patients more satisfied when expectations are met?

    Journal of Family Practice

    (1996)
  • Cited by (0)

    View full text