Changing parents’ opinions regarding antibiotic use in primary care
Eur J Pediatr
Changing parents' opinions regarding antibiotic use in primary care
Yasmin Maor
Meir Raz
Ethan Rubinstein
Estella Derazne
Sigal Ringel
Hector Roizin
Galia Rahav
Gili Regev-Yochay
for the Israeli Judicious Antibiotic Prescription (IJAP) study group
Parents' wish for antibiotics is a significant determinant of antibiotic prescription for their children. The objective of the study was to assess the effect of an educational intervention on parents' attitudes towards antibiotic use. Parents accompanying their children to primary pediatric clinics of Jerusalem-Hashfela District of Maccabi Healthcare Services responded to a survey regarding their wish for antibiotic treatment. Two groups of parents were surveyed: A (control) in a pre-intervention period and B (intervention) during the intervention period. The intervention included posters, pamphlets, and drawing booklets for children in the waiting rooms. A per-protocol analysis that included from group B only parents that stated they noticed the educational material (B1) was also performed. Eight hundred and sixty-eight parents were surveyed during the pre-intervention period and 688 parents during the intervention period. Children's median age was 4 years (8 days-16 years). Most (86%) of the parents were mothers. Groups were similar in socio-demographic characteristics and children's medical complaints. Factors associated with parent's low expectation for antibiotics were a general negative attitude to antibiotics (OR 1.66, 95% CI 1.20-2.30), current upper respiratory tract symptoms (OR 0.29, 95% CI 0.21-0.39), advanced knowledge regarding antibiotics (OR 1.72, 95% CI 1.26-2.34), and being in group B (intervention) (OR 1.47, 95% CI 1.08-2.00). The effect of the intervention was greater in the per-protocol analysis (OR 1.75, 95% CI 1.20-2.55). A simple educational intervention was effective in reducing parents' expectation for antibiotics but was significantly more effective when parents reported they noticed the campaign. Improving parents' knowledge regarding antibiotics can reduce parents' wish for antibiotic treatment.
Antibiotic use; Educational intervention; Antibiotic resistance; Parents' opinions
Introduction
Bacterial resistance is a worldwide problem attributed among
other factors to overuse of antibiotics [
5, 8, 16
]. Children
represent a population of particular concern because they
have high rates of antibiotic use as well as high rates of
respiratory infections with antibiotic-resistant pathogens [
15,
17, 25
]. It has been demonstrated that antibiotic prescribing
for children diagnosed as having colds, upper respiratory
tract infections, and bronchitis, conditions that typically do
not benefit from antibiotics, constitute about 20% of the total
antibiotic prescriptions to children each year [
17
]. Many of
these prescriptions are thought to be unnecessary [
2, 3
].
Parents’ attitudes towards antibiotics are often coupled to
poor knowledge regarding the appropriate use of antibiotics
[
4, 12, 18
]. The physician also has an important role
regarding parents’ attitudes towards antibiotics. In
discussion groups, parents indicated that they would be satisfied
with their physician even if antibiotics were not prescribed,
provided the physician explained the reasons for this
decision [
2
]. Factors associated with antibiotic request
included decreased knowledge of parents regarding
antibiotic use, pressure from day-care settings, lack of
alternatives offered by clinicians, and lack of access to information
[
12
]. These observations suggest that it is possible to change
parents’ attitude regarding antibiotic use for their children
through educational interventions and thus potentially reduce
antibiotics usage.
This study was part of a multifaceted intervention aimed
at promoting judicious antibiotic use (Maccabi IJAP study)
[
20
]. One of the five components of the multifaceted
intervention was “Parents as partners in the fight against
antibiotic resistant bacteria”. The aim of this study was to
evaluate this component and specifically to assess the effect
of the educational intervention on parents’ attitudes towards
antibiotic use in a primary care setup in Israel and to
investigate which factors are important for changing
parents’ expectation for an antibiotic prescription.
Methods
During January 2002, 1 month before the educational
intervention began, a self-response anonymous questionnaire
was administered to 868 parents accompanying their children
to their primary physician in one of 27 primary care pediatric
clinics in Hashfela district of Maccabi Healthcare services (a
major health management organization) in Israel. The
selfresponse questionnaires were administered to parents in the
waiting room and filled out before seeing the physician. The
questionnaire included socio-demographic details, child’s
current symptoms, past antibiotic use, knowledge regarding
indications for receiving antibiotics, knowledge o (...truncated)