Association of antibiotics with veteran visit satisfaction and antibiotic expectations for upper respiratory tract infections

Abstract

Background and objective: Veterans’ Affairs (VA) healthcare providers perceive that Veterans expect and base visit satisfaction on receiving antibiotics for upper respiratory tract infections (URIs). No studies have tested this hypothesis. We sought to determine whether receiving and/or expecting antibiotics were associated with Veteran satisfaction with URI visits. Methods: This cross-sectional study included Veterans evaluated for URI January 2018–December 2019 in an 18-clinic ambulatory VA primary-care system. We evaluated Veteran satisfaction via the Patient Satisfaction Questionnaire Short Form (RAND Corporation), an 18-item 5-point Likert scale survey. Additional items assessed Veteran antibiotic expectations. Antibiotic receipt was determined via medical record review. We used multivariable regression to evaluate whether antibiotic receipt and/or Veteran antibiotic expectations were associated with satisfaction. Subgroup analyses focused on Veterans who accurately remembered antibiotic prescribing during their URI visit. Results: Of 1,329 eligible Veterans, 432 (33%) participated. Antibiotic receipt was not associated with differences in mean total satisfaction (adjusted score difference, 0.6 points; 95% confidence interval [CI], −2.1 to 3.3). However, mean total satisfaction was lower for Veterans expecting an antibiotic (adjusted score difference −4.4 points; 95% CI −7.2 to −1.6). Among Veterans who accurately remembered the visit and did not receive an antibiotic, those who expected an antibiotic had lower mean satisfaction scores than those who did not (unadjusted score difference, −16.6 points; 95% CI, −24.6 to −8.6). Conclusions: Veteran expectations for antibiotics, not antibiotic receipt, are associated with changes in satisfaction with outpatient URI visits. Future research should further explore patient expectations and development of patient-centered and provider-focused interventions to change patient antibiotic expectations.

Evaluation of Multisite Programmatic Bundle to Reduce Unnecessary Antibiotic Prescribing for Respiratory Infections: A Retrospective Cohort Study

“…Of particular importance is the association between antibiotic prescriptions and repeat respiratory-related 14-day respiratory healthcare contact, which was consistent in the overall, pre-, and postintervention cohorts. Previous studies have documented that antibiotic prescriptions are associated with higher patient satisfaction scores [ 29 , 30 ], particularly if patients enter encounters expecting an antibiotic prescription [ 31 ]. It is possible that lack of antibiotic prescription drove certain patients (ie, the inconvincible patients) [ 32 ] to seek prescriptions elsewhere within the health system, thereby driving repeat contact.…”

Determinants of appropriate antibiotic and NSAID prescribing in unscheduled outpatient settings in the veterans health administration

“…[ 35 ] However, recent work by Staub et al found that among patients with respiratory tract infections, receipt of an antibiotic was not independently associated with improved satisfaction. [ 36 ] Instead, they found that receipt of antibiotics had to match the patient’s expectations to affect patient satisfaction and recommended that clinicians communicate with their patients about prescribing expectations. This finding complements our results in the present study and the importance of communication about expectations is similarly important for NSAID prescribing as well.…”