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（阿尔蒂）儿科就诊期间，医生与父母的沟通模式强烈影响抗生素处方率。本研究的总体目标是改善儿科阿尔蒂访视期间医生与家长的沟通模式，并最终降低儿童这些疾病的抗生素处方率。本研究的具体目的是：1）测试一种旨在改善儿科阿尔蒂访视期间医生沟通技能的新型基于沟通的干预措施，2）评价拟议干预措施在实现其改变医生沟通行为的既定目标方面的有效性，3）确定阿尔蒂抗生素处方率和家长满意度水平如何随干预措施而变化，以及4）检查新开发的测量工具--医生沟通行为量表（PCBI）的有效性，该工具旨在评估阿尔蒂访视期间的沟通模式。为了实现这些目标，我们提出了一个随机对照试验的干预措施，涉及34名初级保健儿科医生（17干预和17控制）属于实践中的普吉特湾儿科研究网络在西雅图，华盛顿州的样本。干预的有效性将通过检查在三个时间点收集的2，040次儿科就诊（每名医生60次）的结果来衡量：干预前1-2个月，干预后1-2个月和干预后6-8个月。主要就诊水平结局指标为：阿尔蒂的抗生素处方率和父母对护理的满意度;主要医生结局为父母在PCBI上报告的沟通技能利用的变化。PCBI的有效性将进行评估，通过检查收敛的有效性父母的反应，在这个仪器和实际的通信行为编码的录像带中的一个样本的100个医生，父母的遭遇。门诊抗生素的过度使用导致许多细菌菌株的耐药性迅速发展。在先前的干预研究中，社区一级抗生素处方率的下降降低了抗生素耐药性。如果这种干预措施能有效降低儿童急性呼吸道疾病的抗生素处方率，并且这些改善被证明是持续的，那么这项研究将成为一种有效、可行和可出口的工具，以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.