Antimicrobial prescribing for acute purulent rhinitis in children: a survey of pediatricians and family practitioners

Schwartz, Richard H.; Freij, Bishara J.; Ziai, Mohsen; Sheridan, Michael J.

doi:10.1097/00006454-199702000-00004

Cited by 101 publications

(63 citation statements)

References 19 publications

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“…In studies of antibiotic prescriptions, family physicians were also more likely to prescribe medications. 26,27 There are important distinctions between family physicians and pediatricians that must be considered as research continues in this area. However, until evidence and guidelines provide standards for appropriate SSRI use and better measures of patient outcomes in mental health are developed, terms such as underuse and overuse will be difficult to operationalize.…”

Section: Discussionmentioning

confidence: 99%

Pediatrician and Family Physician Prescription of Selective Serotonin Reuptake Inhibitors

2000

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ABSTRACT. Objectives. Selective serotonin reuptake inhibitor (SSRI) prescriptions for children and adolescents have increased greatly in recent years despite a paucity of demonstrated safety and efficacy data and a lack of clear guidelines for use. Our study sought to describe family physician and pediatrician SSRI prescribing patterns for children and adolescents, identify influences on SSRI prescription variations, and describe the use of SSRI within the overall management of depression and other mental disorders in primary care.Design. A survey was mailed to all 596 active North Carolina general pediatricians and a random sample of 557 family physicians in primary care practice. Family physicians who did not see children in their practice were excluded. The survey instrument consisted of a 4-page questionnaire. Survey items included physician demographics, practice characteristics, general management, volume of pediatric patients with depressive symptoms, prescription of SSRIs for depression and other diagnoses, and potential influences on SSRI prescribing practices. The main outcomes were self-reported physician prescription of SSRIs for children and adolescents. Results were analyzed using 2 comparisons and logistic regression.Results. The overall response rate was 66% (55% family physicians and 76% pediatricians). Of the physicians, 72% had prescribed an SSRI for a child or adolescent. Depression was the most common reason for prescribing an SSRI; over two thirds of respondents had prescribed an SSRI for depression in a child 18 years of age or younger. Over half of the physicians reported they had prescribed an SSRI for a diagnosis other than depression in a child 18 years of age or younger. Attention-deficit/ hyperactivity disorder was the most frequent use cited other than depression, followed by obsessive-compulsive disorder, aggression, eating disorders, and enuresis.Primary care physicians prescribed SSRIs for adolescents more commonly than for younger children. Only 6% of the respondents had ever prescribed an SSRI for a child younger than 6 years of age. In terms of SSRI prescriptions written for depression in the last 6 months, 32% of the physicians had recently prescribed SSRIs for adolescent patients and 6% for patients younger than 12 years of age. Family physicians were more likely than pediatricians to have recently prescribed SSRIs for adolescent patients (41% vs 26%), but there was no difference in recent SSRI prescriptions for children <12 years of age by physician specialty (4% vs 6%).Prescription of SSRIs was not associated with decreased use of counseling for treatment of depression, but prescription of SSRIs was associated with decreased use of referrals (63% vs 74%). There was no difference in the use of counseling between family physicians and pediatricians (61% vs 59%). However, pediatricians were more likely to use referrals in their usual approach to depression (77% vs 48%) compared with family physicians.More family physicians had prescribed SSRIs for pediatric patients compared ...

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Section: Discussionmentioning

confidence: 99%

Pediatrician and Family Physician Prescription of Selective Serotonin Reuptake Inhibitors

2000

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“…Research has shown that parent pressure is commonly cited by physicians as a reason for prescribing (Barden, Dowell, Schwartz, & Lackey, 1998;Palmer & Bauchner, 1997;Schwartz, 1999;Schwartz, Freij, Ziai, & Sheridan, 1997). Several communication practices used by parents appear to be what actually constitutes ''pressure'' (Stivers, 2002a, b, in press;.…”

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confidence: 99%

Non-antibiotic treatment recommendations: delivery formats and implications for parent resistance

Stivers

2005

Social Science & Medicine

147

150

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This study draws on a database of 570 community-based acute pediatric encounters in the USA and uses conversation analysis as a methodology to identify two formats physicians use to recommend non-antibiotic treatment in acute pediatric care (using a subset of 309 cases): recommendations for particular treatment (e.g., ''I'm gonna give her some cough medicine.'') and recommendations against particular treatment (e.g., ''She doesn't need any antibiotics.''). The findings are that the presentation of a specific affirmative recommendation for treatment is less likely to engender parent resistance to a non-antibiotic treatment recommendation than a recommendation against particular treatment even if the physician later offers a recommendation for particular treatment. It is suggested that physicians who provide a specific positive treatment recommendation followed by a negative recommendation are most likely to attain parent alignment and acceptance when recommending a non-antibiotic treatment for a viral upper respiratory illness. r

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“…Among these are the patient's age (Schwartz, Freij, Ziai, & Sheridan, 1997), the duration and worsening of symptoms (Davy, Dick, & Munk, 1998), physical examination findings (Dosh, Hickner, Mainous, & Ebell, 2000;Le Saux, Pham, Table 2 reflect multiple logistic regression, with corrections for clustering of encounters within physician. Column 1: Rows 1a, 1b, and 2a do not significantly differ (p > 0:30 for all pairs).…”

Section: Determinants Of Antibiotic Prescribingmentioning

confidence: 99%

“…Row 2b significantly differs from rows 1a and 1b (po0:05 in both cases), but does not significantly differ from row 2a (p ¼ 0:18) all tests two-sided. Bjornson, & Pitters, 1999), perceived parental expectations for antibiotics (Watson et al, 1999;MangioneSmith et al, 1999), concerns related to maintaining a positive doctor-patient/parent relationship (Butler et al, 1998), the parent's need to return to work (lack of ''sick daycare'' available for their child) (Barden, Dowell, Schwartz, & Lackey, 1998), concern about adverse outcomes if treatment is withheld (Dosh et al, 2000;Butler et al, 1998), physician demographics, and physician specialty (Mainous, Hueston, & Love, 1998;Schwartz et al, 1997).…”

Section: Determinants Of Antibiotic Prescribingmentioning

confidence: 99%

Online commentary during the physical examination: a communication tool for avoiding inappropriate antibiotic prescribing?

Mangione-Smith

Stivers

Elliott

et al. 2003

Social Science & Medicine

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A previously identified communication behavior, online commentary, is physician talk that describes what he/she is seeing, feeling, or hearing during the physical examination of the patient. The investigators who identified this communication behavior hypothesized that its use may be associated with successful physician resistance to perceived or actual patient expectations for inappropriate antibiotic medication. This paper examines the relationship between actual and perceived parental expectations for antibiotics and physician use of online commentary as well as the relationship between online commentary use and the physician's prescribing decision. We conducted a prospective observational study in two private pediatric practices. Study procedures included a pre-visit parent survey, audiotaping of study consultations, and post-visit surveys of the participating physicians. Ten pediatricians participated (participation rate=77%) and 306 eligible parents participated (participation rate=86%) who were attending sick visits for their children with upper respiratory tract infections between October 1996 and March 1997. The main outcomes measured were the proportion of consultations with online commentary and the proportion of consultations where antibiotics were prescribed. Two primary types of online commentaries were observed: (1) online commentary suggestive of a problematic finding on physical examination that might require antibiotic treatment ('problem' online commentary), e.g., ''That cough sounds very chesty''; and (2) online commentary that indicated the physical examination findings were not problematic and antibiotics were probably not necessary ('no problem' online commentary), e.g., ''Her throat is only slightly red''. For presumed viral cases where the physician thought the parent expected to receive antibiotics, if the physician used at least some 'problem' online commentary, he/she prescribed antibiotics in 91% (10/11) of cases. Conversely, when the physician exclusively employed 'no problem' online commentary, antibiotics were prescribed 27% (4/15) of the time (p ¼ 0:07). Use of 'no problem' online commentary did not add significantly to visit length. 'No problem' online commentary is a communication technique that may provide an effective and efficient method for resisting perceived expectations to prescribe antibiotics. r

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Antimicrobial prescribing for acute purulent rhinitis in children: a survey of pediatricians and family practitioners

Abstract: Most infants and children with acute purulent rhinitis of short duration were treated with antibiotics despite professed concerns over the spread of bacterial resistance; the practice was more prevalent among FP.

Cited by 101 publications

References 19 publications

Pediatrician and Family Physician Prescription of Selective Serotonin Reuptake Inhibitors

Pediatrician and Family Physician Prescription of Selective Serotonin Reuptake Inhibitors

Non-antibiotic treatment recommendations: delivery formats and implications for parent resistance

Online commentary during the physical examination: a communication tool for avoiding inappropriate antibiotic prescribing?

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