Health Providers’ Advising on Symptom Management for Upper Respiratory Tract Infections: Does Elaboration of Reasoning Influence Outcomes Relevant to Antibiotic Stewardship?

Abstract

Antibiotic-resistant infections, fueled by unwarranted antibiotic prescribing, are an increasing threat to public health. Reducing overprescribing and promoting antibiotic stewardship requires managing patient expectations for and understanding about the utility of antibiotics. One hotspot for overprescribing is upper respiratory tract infections, for which the best treatment is often non-antibiotic symptom management behaviors. Guided by advice response theory, the current study examines how providers’ reason-giving for symptom management advice affected perceptions of advice quality, efficacy for symptom monitoring and management, and satisfaction with care for patients who were not prescribed antibiotics for their upper respiratory tract infections. Transcribed medical visits were coded for symptom management advice reason-giving and patients completed post-visit surveys. Greater provider elaboration about instruction was independently and positively associated with evaluations of advice quality. Results also indicate several significant interactions between types of reason-giving. Implications of these findings for advice theory and clinical practice are addressed in the discussion.

“Watchful Waiting” Advice for Pediatric Ear Infections

“…of the advised action, and correspondingly, that effective advising entails successfully addressing those issues (Feng & Burleson, 2008). Recent work on advising in health care (Foley et al, 2020) suggests that advisors’ instruction also matters, especially when advised actions are unfamiliar or difficult. When providers explain the nature of the illness and the adverse effects of antibiotics, they address issues of WW efficacy—both the inefficacy of using antibiotics and the efficacy of avoiding them.…”

“…The majority of these prescriptions are unnecessary, as most AOM cases are viral, and the bacterial ones also typically resolve without antibiotic treatment (Fleming-Dutra et al, 2016; Vaz et al, 2014). Due to the growing public health threat from antibiotic resistance and its association with unnecessary antibiotic use (see Foley et al, 2020), AOM has become a central target for improving antibiotic stewardship in pediatrics (Hicks et al, 2015; Vaz et al, 2014). In 2013, the American Academy of Pediatrics (AAP) issued revised clinical guidelines for AOM treatment, placing greater emphasis on the use of “watchful waiting” (WW) as a way of treating AOM.…”