Reducing unwarranted antibiotic use for pediatric acute otitis media: the influence of physicians' explanation and instruction on parent compliance with ‘watchful waiting’

MacGeorge, Erina L.; Caldes, Emily P.; Smith, Rachel A.; Hackman, Nicole M.; Jose, Alyssa San

doi:10.1080/00909882.2017.1320575

Cited by 18 publications

(18 citation statements)

References 30 publications

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“…11 Research is also needed to identify WW practices that boost utilization and compliance. 10,12,13 For example, alternative language and methods for discussing WW prescriptions during medical visits might be tested for efficacy. In addition, research should examine how physicians and pharmacists can collaborate to promote WW.…”

Section: Resultsmentioning

confidence: 99%

Diagnostic Accuracy, Prescription Behavior, and Watchful Waiting Efficacy for Pediatric Acute Otitis Media

Brinker

MacGeorge

Hackman

2018

Clin Pediatr (Phila)

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Current guidelines recommend “watchful waiting” (WW) as an alternative to immediate antibiotic treatment. Continued high rates of antibiotic use suggest that WW may be underutilized. We conducted a retrospective chart review of 474 pediatric acute otitis media (AOM) cases at a clinic in central Pennsylvania. We assessed physical examination findings, diagnostic behavior, WW utilization, prescription writing, and filling in cases of pediatric AOM to evaluate the underutilization of WW. We evaluate diagnostic consistency with published guidelines and rates of antibiotic prescription resulting from misdiagnosis. We report WW instructions and compliance, and prescription filling behaviors. Fifty percent of AOM diagnoses in this sample were not supported by physical examination findings. The majority of these AOM diagnoses received antibiotic prescriptions, suggesting that unsupported diagnoses translated to injudicious prescribing. WW instructions corresponded to 57% fewer filled prescriptions and longer fill delay. We discuss the implications and recommendations to improve antibiotic stewardship.

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Section: Resultsmentioning

confidence: 99%

Diagnostic Accuracy, Prescription Behavior, and Watchful Waiting Efficacy for Pediatric Acute Otitis Media

Brinker

MacGeorge

Hackman

2018

Clin Pediatr (Phila)

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“…The steps of teachback are as follows: (Table 3). A recent study indicates that parental compliance with watchful waiting for their children was predicted by physician explanation and instruction [34]. However, few parents indicated that they received explanations about the antibiotic risk and potential adverse effect(s).…”

Section: Strengthen Health Literate Verbal Communication Skillsmentioning

confidence: 99%

Decreasing the Peril of Antimicrobial Resistance Through Enhanced Health Literacy in Outpatient Settings: An Underrecognized Approach to Advance Antimicrobial Stewardship

Hermsen

MacGeorge

Andresen³

et al. 2020

Adv Ther

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Globally, antimicrobial resistance (AMR) is a serious problem causing 700,000 deaths annually. By 2050, AMR is expected to cause approximately 10 million deaths globally each year if allowed to increase at the present rate. Many individuals have limited knowledge regarding appropriate antibiotic use and AMR. Most antibiotic use occurs in the outpatient setting, with approximately 30% of antibiotics prescribed deemed unnecessary. Antimicrobial stewardship (AMS) is a means to reduce inappropriate antibiotic use and AMR. While existing AMS efforts generally focus on the inpatient setting, a significant gap is present in the outpatient setting. A common theme across various national action plans to reduce AMR is the need for education and awareness. The importance of communicating information in a manner easily comprehended by the patient in addition to productive clinician-patient dialogue cannot be overestimated. Enhancing the public's and patients' AMS health literacy is an underrecognized approach to help address AMR. We describe Four Core Elements of Enhancing AMS Health Literacy in the Outpatient Setting, utilizing the Centers for Disease Control and Prevention's framework: (1) leadership commitment, (2) intervention/action, (3) tracking/ reporting, and (4) education/expertise. We call upon leaders in outpatient settings to embrace this approach to curb inappropriate antimicrobial use.

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“…3,4 There is significant parental uncertainty regarding treatment of AOM and less than 30% of U.S. parents receive instructions on appropriate analgesia for their children. 5,6 Discharge instruction complexity and inadequate comprehension is associated with medication errors, suboptimal postdischarge care, and unnecessary recidivism. [7][8][9][10] Medication errors can be reduced using standardized discharge instructions, and parents prefer these to verbal summaries.…”

Section: Introductionmentioning

confidence: 99%

Hot Off the Press: Video for Acute Otitis Media Discharge Instructions

Bond

Morgenstern

Heitz

et al. 2020

Academic Emergency Medicine

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Reducing unwarranted antibiotic use for pediatric acute otitis media: the influence of physicians' explanation and instruction on parent compliance with ‘watchful waiting’

Cited by 18 publications

References 30 publications

Diagnostic Accuracy, Prescription Behavior, and Watchful Waiting Efficacy for Pediatric Acute Otitis Media

Diagnostic Accuracy, Prescription Behavior, and Watchful Waiting Efficacy for Pediatric Acute Otitis Media

Decreasing the Peril of Antimicrobial Resistance Through Enhanced Health Literacy in Outpatient Settings: An Underrecognized Approach to Advance Antimicrobial Stewardship

Hot Off the Press: Video for Acute Otitis Media Discharge Instructions

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