Improving Communication during Pediatric Visits for Acute Respiratory Illness

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DESCRIPTION (provided by applicant): Prior research has demonstrated that physician-parent communication patterns during pediatric visits for acute respiratory tract infections (ARTI) strongly influence antibiotic prescribing rates. The overall goal of this study is to improve physician-parent communication patterns during visits for pediatric ARTI and, ultimately, to decrease rates of antibiotic prescribing for these illnesses in children. The specific aims of the study are:1) to test a novel communication-based intervention designed to improve physician communication skills during visits for pediatric ARTI, 2) to evaluate the effectiveness of the proposed intervention in achieving its stated goals of changing physician communication behaviors, 3) to determine how rates of antibiotic prescribing for ARTI and parent satisfaction levels change as a function of the intervention, and 4) to examine the validity of a newly developed measurement tool, the Physician Communication Behavior Inventory (PCBI), aimed at assessing communication patterns during ARTI visits. To accomplish these aims, we propose a randomized controlled trial of the intervention involving a sample of 34 primary care pediatricians (17 intervention and 17 control) belonging to practices in the Puget Sound Pediatric Research Network in Seattle, WA. The intervention's effectiveness will be measured by examining outcomes in 2,040 pediatric encounters (60 per physician) collected over three points in time: 1-2 months prior to the intervention, 1-2 months post-intervention, and 6-8 months post-intervention. The primary encounter- level outcome measures will be: antibiotic prescribing rates for ARTI and parent satisfaction with care; the primary physician outcome will be changes in the utilization of the communication skills as reported by parents on the PCBI. The validity of the PCBI will be evaluated by examining convergent validity between parent responses on this instrument and actual communication behaviors coded from video tapes in a sample of 100 physician-parent encounters. The excessive use of outpatient antibiotics has contributed to the rapid development of resistance in many strains of bacteria. In prior intervention studies, decreasing rates of antibiotic prescribing at the community level has decreased antibiotic resistance. If this intervention is effective in decreasing antibiotic prescribing rates for acute respiratory illnesses in children and these improvements are shown to be sustained, this study will result in an efficient, feasible, and exportable tool to further address this critically important public health problem in the United States.