Racial/Ethnic Variation in Parent Expectations for Antibiotics: Implications for Public Health Campaigns

Abstract

ABSTRACT. Context. Widespread overuse and inappropriate use of antibiotics are a major public health concern. Little is known about racial/ethnic differences in parents seeking antibiotics for their children's upper respiratory illnesses.Objective. To examine racial/ethnic differences in parent expectations about the need for antibiotics and physician perceptions of those expectations.Design. We conducted a nested, cross-sectional survey of parents who were coming to see their child's pediatrician because of cold symptoms between October 2000 and June 2001. Parents completed a previsit survey that collected information on demographics, their child's illness, and a 15-item previsit expectations inventory that included an item asking how necessary it was for the physician to prescribe antibiotics. Physicians completed a postvisit survey that collected information on diagnosis, treatment, and whether the physician perceived the parent expected an antibiotic. The encounter was the unit of analysis. Multivariate logistic regression analyses were performed to evaluate predictors of dichotomized parental expectations for antibiotics, dichotomized physician perceptions of those expectations, diagnostic patterns, and antibiotic-prescribing patterns.Setting. Twenty-seven community pediatric practices in the Los Angeles, Calif, metropolitan area.Participants. A volunteer sample of 38 pediatricians (participation rate: 64%) and a consecutive sample of 543 parents (participation rate: 83%; ϳ15 participating for each enrolled pediatrician) seeking care for their children's respiratory illnesses. Pediatricians were eligible to participate if they worked in a community-based managed care practice in the Los Angeles area. Parents were eligible to participate if they could speak and read English and presented to participating pediatricians with a child 6 months to 10 years old who had cold symptoms but had not received antibiotics within 2 weeks.Main Outcome Measures. Parental beliefs about the necessity of antibiotics for their child's illness, physician perceptions of parental expectations for antibiotics, bacterial diagnosis rates, and antibiotic-prescribing rates.Results. Forty-three percent of parents believed that antibiotics were definitely necessary, and 27% believed that they were probably necessary for their child's illness. Latino and Asian parents were both 17% more likely to report that antibiotics were either definitely or probably necessary than non-Hispanic white parents. Physicians correctly perceived that Asian parents expected antibiotics more often than non-Hispanic white parents but underestimated the greater expectations of Latino parents for antibiotics. Physicians also correctly perceived that parents of children with ear pain or who were very worried about their child's condition were significantly more likely to expect antibiotics. Physicians were 7% more likely to make a bacterial diagnosis and 21% more likely to prescribe antibiotics when they perceived that antibiotics were expected.Conclusions. Paren...

Race, Otitis Media, and Antibiotic Selection

“…31 When providers perceive that parents expect antibiotics, they are more likely to assign a bacterial diagnosis and to prescribe antibiotics. 32,33 Additionally, patient race appears to affect whether providers perceive that parents expect antibiotics. 32 Thus, subjective diagnoses and antibiotic selection may be influenced by race via possible differences in parent expectations and interactions with providers.…”

“…32,33 Additionally, patient race appears to affect whether providers perceive that parents expect antibiotics. 32 Thus, subjective diagnoses and antibiotic selection may be influenced by race via possible differences in parent expectations and interactions with providers. Similarly, receiving care in an emergency department was associated with lower odds of receiving broad-spectrum antibiotics for OM, suggesting that office-based providers may be more susceptible to factors such as perceived parent demand for antibiotics and concerns about parent satisfaction and patient retention.…”

Parental Health Literacy, Knowledge and Beliefs Regarding Upper Respiratory Infections (URI) in an Urban Latino Immigrant Population

“…10 More specifically, Latino parents have been shown to be at increased risk for poor health literacy regarding upper respiratory infections (URIs) in comparison to nonLatino Whites and Latino parents have been shown to be significantly more likely to expect antibiotic treatment for a child in comparison to non-Hispanic white parents. 11 Nonjudicious use of antibiotics, including antimicrobial treatment of viral URI in pediatric settings, has contributed to the public health threat of antimicrobial resistance. 12 Young children aged 6 months to 3 years have an average of five URIs per year, 13 and lower parental health literacy is associated with poorer health outcomes, most notably for younger children.…”

What Happens When “Germs Don't Get Killed and They Attack Again and Again”: Perceptions of Antimicrobial Resistance in the Context of Diarrheal Disease Treatment Among Laypersons and Health-Care Providers in Karachi, Pakistan

“…In addition, developing and evaluating impactful behavior change interventions for health consumers and providers is challenging, complicated by varying social, cultural, and economic circumstances. 25,26 We focused on three primary areas of understanding: awareness, perceived causes and implications, and community-identified solutions for antimicrobial resistance. Considered in combination with other research, our findings support several potential strategies to combat antimicrobial resistance.…”