Improving Communication during Pediatric Visits for Acute Respiratory Illness

描述(由申请人提供)：先前的研究表明，在急性呼吸道感染(ARTI)儿科就诊期间，医生与父母的沟通模式对抗生素处方率有很大影响。这项研究的总体目标是改善儿科ARTI就诊期间医生与父母的沟通模式，并最终降低儿童这些疾病的抗生素处方率。这项研究的具体目的是：1)测试一种新型的基于沟通的干预措施，旨在提高ARTI儿科就诊期间的医生沟通技能；2)评估拟议的干预措施在实现改变医生沟通行为的既定目标方面的有效性；3)确定ARTI的抗生素处方率和家长满意度如何随干预措施的变化而变化；以及4)检查新开发的测量工具--医生沟通行为问卷(PCBI)的有效性，该工具旨在评估ARTI就诊期间的沟通模式。为了实现这些目标，我们提出了一项干预的随机对照试验，涉及华盛顿州西雅图普吉特湾儿科研究网络的34名初级保健儿科医生的样本(17名干预和17名对照)。干预的有效性将通过检查在三个时间点上收集的2040次儿科会诊(每个医生60次)的结果来衡量：干预前1-2个月，干预后1-2个月，以及干预后6-8个月。主要的接触水平结果将是：ARTI的抗生素处方率和父母对护理的满意度；初级医生的结果将是父母在PCBI上报告的沟通技能利用的变化。PCBI的有效性将通过在100次医生-家长会面的样本中检查家长对该仪器的反应与从录像带中编码的实际沟通行为之间的收敛有效性来评估。门诊抗生素的过度使用导致了许多菌株的耐药性迅速发展。在先前的干预研究中，社区层面抗生素处方率的下降降低了抗生素耐药性。如果这项干预措施在降低儿童急性呼吸道疾病的抗生素处方率方面有效，并且这些改善被证明是持续的，这项研究将产生一种有效、可行和可出口的工具，进一步解决美国这一至关重要的公共卫生问题。

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.