Changing parents’ opinions regarding antibiotic use in primary care

European Journal of Pediatrics, Mar 2011

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.

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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)


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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. Changing parents’ opinions regarding antibiotic use in primary care, European Journal of Pediatrics, 2011, pp. 359-364, Volume 170, Issue 3, DOI: 10.1007/s00431-010-1301-9