The relationship between perceived parental expectations and pediatrician antimicrobial prescribing behavior
The relationship between perceived parental expectations and pediatrician antimicrobial prescribing behavior
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DOI：
10.1542/peds.103.4.711
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发表时间：
1999-04-01
期刊：
影响因子：
8
通讯作者：
Brook, RH
中科院分区：
文献类型：
--
作者：
Mangione-Smith, R;McGlynn, EA;Brook, RH
语境。尽管人们越来越担心不断升级的抗菌药物耐药性问题，但医生仍然继续不恰当地开药。有人提出，儿科医生抗菌药物处方行为的一个主要决定因素是父母对提供处方的期望。目标。探讨父母预诊期望和医生对这些期望的看法与不适当的抗菌药物处方相关的程度；并探讨期望的实现与家长访问特定满意度之间的关系。设计。家长的访前和访后调查以及医生的访后调查。设置。两个私人儿科诊所，一个基于社区，一个基于大学。参与者。 10 名医生（答复率 = 77%）和 306 名符合资格的家长（答复率 = 86%）的连续样本，这些家长在 1996 年 10 月至 1997 年 3 月期间为孩子进行了病假检查。家长在两个诊所的候诊室接受了资格筛查，如果他们会说和读英语，并且孩子年龄在 2 至 10 岁，有耳痛、咽喉痛、咳嗽或鼻塞症状，则被邀请参加。在过去 2 周内停止抗菌治疗，正在看一位参与的医生。主要结果指标。抗菌药物处方决定、分配细菌诊断的概率以及家长特定就诊的满意度。结果。根据多变量分析，医生对父母对抗菌药物的期望的看法是针对假定的病毒病因开抗菌药物的唯一重要预测因素；当医生认为父母需要抗菌药物时，62% 的人会开出处方药，而当医生认为父母不需要抗菌药物时，这一比例为 7%。然而，医生的抗菌药物处方行为与父母对接受抗菌药物的实际期望无关。此外，当医生认为父母需要抗菌药物时，他们也更有可能给出细菌诊断（70% 的时间 vs 31% 的时间）。未能满足家长对访问期间沟通事件的期望是家长满意度的唯一重要预测因素。未能提供预期的抗菌药物并不影响满意度。结论。抗生素耐药性的流行应该会导致这项研究立即在更广泛的人群中得到复制。如果证实医生对家长需要使用抗菌药物治疗病毒感染的看法不准确，则应采取干预措施来改变医生获得这组看法的方式。
Context. Despite growing concern over the escalating antimicrobial resistance problem, physicians continue to inappropriately prescribe. It has been suggested that a major determinant of pediatrician antimicrobial prescribing behavior is the parental expectation that a prescription will be provided.Objectives. To explore the extent to which parental previsit expectations and physician perceptions of those expectations are associated with inappropriate antimicrobial prescribing; and to explore the relationship between fulfillment of expectations and parental visit-specific satisfaction.Design. Previsit and postvisit survey of parents and postvisit survey of physicians.Setting. Two private pediatric practices, one community based and one university based.Participants. Ten physicians (response rate = 77%), and a consecutive sample of 306 eligible parents (response rate = 86%) who were attending sick visits for their children between October 1996 and March 1997. Parents were screened for eligibility in the waiting rooms of the two practices and were invited to participate if they spoke and read English and their child was 2 to 10 years old, had a presenting complaint of ear pain, throat pain, cough, or congestion, was off antimicrobial therapy for the past 2 weeks, and was seeing one of the participating physicians.Main Outcome Measures. Antimicrobial prescribing decision, probability of assigning a bacterial diagnosis, and parental visit-specific satisfaction.Results. Based on multivariate analysis, physicians' perceptions of parental expectations for antimicrobials was the only significant predictor of prescribing antimicrobials for conditions of presumed viral etiology; when physicians thought a parent wanted an antimicrobial, they prescribed them 62% of the time versus 7% of the time when they did not think the parent wanted antimicrobials. However, physician antimicrobial prescribing behavior was not associated with actual parental expectations for receiving antimicrobials. In addition, when physicians thought the parent wanted an antimicrobial, they were also significantly more likely to give a bacterial diagnosis (70% of the time versus 31% of the time). Failure to meet parental expectations regarding communication events during the visit was the only significant predictor of parental satisfaction. Failure to provide expected antimicrobials did not affect satisfaction.Conclusions. The antibiotic resistance epidemic should lead to immediate replication of this study in a larger more generalizable population. If inaccurate physician perceptions of parent desires for antimicrobials for viral infections are confirmed, then an intervention to change the way physicians acquire this set of perceptions should be undertaken.