A new UCLA study shows how communication techniques between a doctor and parents can result in increased parents’ satisfaction with the treatment plan for their child’s upper respiratory illness and avoid unnecessary antibiotic prescriptions.
The findings, being presented May 3 at the Pediatric Academic Society’s annual meeting in San Francisco, Calif., concluded that focusing positively on what can be done to make a child feel better, rather than on what is not needed (antibiotics), can increase parents’ acceptance of non-antibiotic treatment and satisfaction with care.
“Oftentimes, the dynamics of a doctor-parent interaction leads the pediatrician to perceive that parents expect a prescription for antibiotics, and this can lead to unnecessary prescribing,� said Dr. Rita Mangione-Smith, lead investigator of the study and a pediatrician at Mattel Children’s Hospital at UCLA. “We wanted to examine communication techniques that assist physicians in avoiding inappropriate antibiotic prescribing while at the same time maintaining parent satisfaction with the visit.�
According to Mangione-Smith, studies show that patients with respiratory illnesses receive antibiotics 30 percent of the time. However, 55 percent of antibiotic prescriptions for these illnesses are not needed — and inappropriate use can lead to antibiotic-resistant infections.
To conduct the study, researchers collected data using videotapes and three survey instruments on a sample of 543 pediatric doctor visits in 27 Los Angeles-based practices from October 2000 to June 2001. Thirty-eight physicians were recruited with about 15 eligible parents for each doctor.
Researchers analyzed conversations for recurrent patterns of communication deemed relevant to the study objectives. Pediatricians used two formats for recommending treatment. One was a “positive� format where the doctor explained what could be done for the child. The second was a “negative� format where the doctor ruled out the need for treatment(s).
The study showed that the negatively formatted treatment recommendations resulted in significantly higher odds that parents would disagree with a non-antibiotic treatment plan.
When a parent disagreed with the treatment plan, there was a three-fold increase in the odds that the doctor would perceive that parent as expecting antibiotics. When pediatricians believed the parent expected antibiotics, they were then 22 percent more likely to prescribe them.
“When parents bring their young children to see us, many times they have been up all night with an irritable child who is congested and could not sleep. What we need to do when we see these children in the office and find they have the common cold is acknowledge there is a problem and focus on telling the parent things they can do to help their child feel better. We need to avoid telling parents, ‘This is just a cold and we don’t need any antibiotics,’� Mangione-Smith said.
While parents’ satisfaction with care wasn’t hindered by not getting a prescription for antibiotics, their satisfaction was decreased if the doctor failed to give advice on how to make their child feel better.
The research was funded by grants from the Robert Wood Johnson Foundation of Princeton, N.J., and the Agency for Healthcare Research and Quality.
Mattel Children’s Hospital at UCLA offers a full spectrum of primary and specialized medical care for infants, children and adolescents. Its mission is to provide treatment for children in a compassionate atmosphere, as well as to conduct research that improves the understanding and treatment of pediatric cases. For more information, please visit www.mattel.ucla.edu.