Project Summary
Antibiotic overuse and misuse contribute to adverse drug reactions and the development of antibiotic resistant infections that kill at least 23,000 Americans and cause an additional 2 million infections annually. The majority of all antibiotic prescribing occurs in clinics where children receive 49 million prescriptions annually. Children with acute respiratory tract infections receive over 70 percent of these prescriptions, of which, 29 percent are unnecessary (e.g., either to treat a viral illness or an unnecessary broad-spectrum antibiotic). Inappropriate antibiotic prescribing is often the result of ineffective parent–provider communication born out of providers’ assumptions of parents’ desires for antibiotics and concerns about parental satisfaction. While previous studies have indirectly examined the impact of parent–provider communication on appropriate antibiotic prescribing, no studies have examined the comparative effectiveness of a parent–provider communication intervention versus a parent–provider education intervention on increasing shared decision making, quality of the communication, parent satisfaction, and appropriate use of antibiotics.
This study will compare the impact of two proven approaches for reducing inappropriate antibiotic prescribing (one that targets parent and provider education versus one that targets patient–provider communication) on the quality of parent–provider communication, shared decision making, and appropriate antibiotic prescribing. A multisite randomized controlled trial will be performed. A total of 1,600 parents of children between the ages of 1 and 5 years will be recruited for study participation. Each participant will see a physician who has been randomized to either the parent–provider education or the parent–provider communication intervention arm. At the end of each visit, parental ratings of the quality of the patient–provider communication, shared decision making and satisfaction will be examined. At the conclusion of the study, the effect of each intervention on providers’ antibiotic prescribing will be compared.
This study will be the first to date to demonstrate the comparative effectiveness of two proven strategies (parent–provider communication skills intervention versus parent–provider education intervention) to stimulate shared decision making and judicious use of antibiotics. The Parent Co-investigator and other parent, provider, and community stakeholders have guided the proposed study design and will continue to be engaged during every phase of the research process, including the study’s implementation, data analysis and interpretation, and the dissemination of study findings. This study could have significant public health implications and meet the goals outlined in President Obama’s 2014 Executive Order on Combating Antibiotic Resistance, which seeks to slow the emergence of resistant bacteria and prevent the spread of resistant infections through the judicious and appropriate use of antibiotics.
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