Do parents and physicians differ in making decisions about acute otitis media?

OBJECTIVES We wanted to discover how parents differ from physicians in making decisions about how to treat a child who may have acute otitis media (AOM). STUDY DESIGN We used questionnaires that required participants to judge the probability of AOM or choose treatment for 2 sets of 46 paper scenarios of hypothetical children aged 15 months who might have AOM, and they subsequently rated the importance of individual cues and described their attitudes and opinions related to health care and AOM. POPULATION Convenience samples of 19 US family physicians, 35 French generalists, 21 French pediatricians, 52 US parents, and 86 French parents were included. OUTCOMES MEASURED The primary outcomes were the judgment policies-the weights placed on each of the scenario cues when making decisions-that were derived for each individual and each group by multiple linear regression. RESULTS The mean judged probabilities of AOM were nearly the same for all groups: 50% for the US physicians, 51% for the US parents, 52.5% for the French physicians, and 52% for the French parents. The percentages of cases treated with antibiotics did not differ: 53% for US physicians, 45% for US parents, 53% for French physicians, and 51% for French parents. All groups gave greatest weight to the physical examination cues for decisions about both diagnosis and treatment. The parents paid little attention to the cues that reflected parental concerns. CONCLUSIONS US and French parents were very similar to physicians in their judgments and treatment choices regarding AOM. They appear to be able to adopt the physician's point of view and to be selective in the use of antibiotics.

[1]  B. Quinet Antibiothérapie des infections cutanées de l'enfant , 2001 .

[2]  M. Dekay,et al.  Further Explorations of Medical Decisions for Individuals and for Groups , 2000, Medical decision making : an international journal of the Society for Medical Decision Making.

[3]  M. Pichichero,et al.  Understanding antibiotic overuse for respiratory tract infections in children. , 1999, Pediatrics.

[4]  M. Kolczak,et al.  Antimicrobial use for pediatric upper respiratory infections: reported practice, actual practice, and parent beliefs. , 1999, Pediatrics.

[5]  F. Furstenberg,et al.  Working parents: what factors are involved in their ability to take time off from work when their children are sick? , 1999, Archives of pediatrics & adolescent medicine.

[6]  J. Steiner,et al.  Decreasing antibiotic use in ambulatory practice: impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults. , 1999, JAMA.

[7]  R H Brook,et al.  The Relationship Between Perceived Parental Expectations and Pediatrician Antimicrobial Prescribing Behavior , 1999, Pediatrics.

[8]  H. Bauchner,et al.  Parents, physicians, and antibiotic use. , 1999, Pediatrics.

[9]  P. Sorum Measuring Patient Preferences by Willingness to Pay to Avoid , 1999, Medical decision making : an international journal of the Society for Medical Decision Making.

[10]  S. Dowell,et al.  Current Attitudes Regarding Use of Antimicrobial Agents: Results from Physicians' and Parents' Focus Group Discussions , 1998, Clinical pediatrics.

[11]  P. Berche,et al.  Pathogens isolated during treatment failures in otitis. , 1998, The Pediatric infectious disease journal.

[12]  R. Pill,et al.  Understanding the culture of prescribing: qualitative study of general practitioners' and patients' perceptions of antibiotics for sore throats , 1998, BMJ.

[13]  N. Britten,et al.  Influence of Patientsʼ Expectations on Antibiotic Management of Acute Lower Respiratory Tract Illness in General Practice: Questionnaire Study , 1998 .

[14]  E. John Orav,et al.  The Association of Physician Attitudes about Uncertainty and Risk Taking with Resource Use in a Medicare HMO , 1998, Medical decision making : an international journal of the Society for Medical Decision Making.

[15]  H. Bauchner,et al.  Reducing Inappropriate Oral Antibiotic Use: A Prescription for Change , 1998, Pediatrics.

[16]  J. Mumpower,et al.  Physicians' Diagnostic Judgments and Treatment Decisions for Acute Otitis Media in Children , 1998, Medical decision making : an international journal of the Society for Medical Decision Making.

[17]  J F Steiner,et al.  Antibiotic prescribing for children with colds, upper respiratory tract infections, and bronchitis. , 1998, JAMA.

[18]  A. Mainous,et al.  Why do physicians prescribe antibiotics for children with upper respiratory tract infections? , 1998, JAMA.

[19]  D. Guillemot [Are antibiotics over-consumed+?]. , 1998, La Revue du praticien.

[20]  B. Balkau,et al.  Low dosage and long treatment duration of beta-lactam: risk factors for carriage of penicillin-resistant Streptococcus pneumoniae. , 1998, JAMA.

[21]  B. Balkau,et al.  Trends in antimicrobial drug use in the community--France, 1981-1992. , 1998, The Journal of infectious diseases.

[22]  S. Dowell,et al.  Otitis Media—Principles of Judicious Use of Antimicrobial Agents , 1998, Pediatrics.

[23]  B. Lindgren,et al.  Knowledge and attitudes about otitis media risk: implications for prevention. , 1997, Pediatrics.

[24]  J. Froom,et al.  Routine antimicrobial treatment of acute otitis media: is it necessary? , 1997, JAMA.

[25]  J. Marshall Are antibiotics indicated as initial treatment for children with acute otitis media? A meta-analysis , 1997 .

[26]  M. Kochen,et al.  Are patients more satisfied when they receive a prescription? The effect of patient expectations in general practice. , 1997, Scandinavian journal of primary health care.

[27]  J. Cockburn,et al.  Prescribing behaviour in clinical practice: patients' expectations and doctors' perceptions of patients' expectations—a questionnaire study , 1997, BMJ.

[28]  K Kroenke,et al.  Concerns and expectations in patients presenting with physical complaints. Frequency, physician perceptions and actions, and 2-week outcome. , 1997, Archives of internal medicine.

[29]  L Culpepper,et al.  Antimicrobials for acute otitis media? a review from the international primary care network , 1997, BMJ.

[30]  A. Mainous,et al.  Patient knowledge of upper respiratory infections: implications for antibiotic expectations and unnecessary utilization. , 1997, The Journal of family practice.

[31]  H. Bauchner,et al.  Parents' and physicians' views on antibiotics. , 1997, Pediatrics.

[32]  E. Bingen,et al.  Change in nasopharyngeal carriage of Streptococcus pneumoniae resulting from antibiotic therapy for acute otitis media in children. , 1997, The Pediatric infectious disease journal.

[33]  M. Sheridan,et al.  Antimicrobial prescribing for acute purulent rhinitis in children: a survey of pediatricians and family practitioners. , 1997, The Pediatric infectious disease journal.

[34]  Kristine M. Kuhn,et al.  The Relative Importance of Probabilities, Outcomes, and Vagueness in Hazard Risk Decisions , 1996 .

[35]  J. Kai,et al.  Parents' difficulties and information needs in coping with acute illness in preschool children: a qualitative study , 1996, BMJ.

[36]  R. Hamm,et al.  Antibiotics and respiratory infections: do antibiotic prescriptions improve outcomes? , 1996, The Journal of the Oklahoma State Medical Association.

[37]  R. Hamm,et al.  Antibiotics and respiratory infections: are patients more satisfied when expectations are met? , 1996, The Journal of family practice.

[38]  H. Bauchner,et al.  Therapy for acute otitis media. Preference of parents for oral or parenteral antibiotic. , 1996, Archives of pediatrics & adolescent medicine.

[39]  J. Paradise Managing otitis media: a time for change. , 1995, Pediatrics.

[40]  J. Hughes,et al.  Trends in antimicrobial drug prescribing among office-based physicians in the United States. , 1995, JAMA.

[41]  G A Chase,et al.  Measuring Physicians' Tolerance for Ambiguity and its Relationship to Their Reported Practices Regarding Genetic Testing , 1993, Medical care.

[42]  D. Vinson,et al.  The effect of parental expectations on treatment of children with a cough: a report from ASPN. , 1993, The Journal of family practice.

[43]  D R Holtgrave,et al.  Physicians' Risk Attitudes, Laboratory Usage, and Referral Decisions , 1991, Medical decision making : an international journal of the Society for Medical Decision Making.

[44]  D M Chaput de Saintonge,et al.  Clinical judgment analysis. , 1990, The Quarterly journal of medicine.

[45]  D A Redelmeier,et al.  Discrepancy between medical decisions for individual patients and for groups. , 1990, The New England journal of medicine.

[46]  L Culpepper,et al.  Diagnosis and antibiotic treatment of acute otitis media: report from International Primary Care Network. , 1990, BMJ.

[47]  Lavonne B. Bergstrom,et al.  Otitis Media in Infants and Children , 1989 .

[48]  J. Paradise,et al.  On classifying otitis media as suppurative or nonsuppurative, with a suggested clinical schema. , 1987, The Journal of pediatrics.

[49]  L. Hattersley,et al.  Antibiotics for otitis media: can we help doctors agree? , 1985, Family practice.

[50]  D M Chaput de Saintonge,et al.  Clinical judgment in rheumatoid arthritis. I. Rheumatologists' opinions and the development of 'paper patients'. , 1983, Annals of the rheumatic diseases.

[51]  D. M. Chaput de Saintonge,et al.  Antibiotic use in otitis media: patient simulations as an aid to audit. , 1981, British medical journal.

[52]  G. Hayden Acute Suppurative Otitis Media in Children , 1981, Clinical pediatrics.

[53]  William H. Clover,et al.  Can we learn anything about interviewing real people from “interviews” of paper people? Two studies of the external validity of a paradigm☆ , 1978 .

[54]  Otite Moyenne Aiguë ANTIBIOTHERAPIE PAR VOIE GENERALE EN PRATIQUE COURANTE , 2001 .

[55]  G. Gates,et al.  Measuring the indirect and direct costs of acute otitis media. , 1999, Archives of otolaryngology--head & neck surgery.

[56]  Abrams Js,et al.  Bacterial resistance due to antimicrobial drug addiction among physicians. Time for a cure , 1999 .

[57]  J. Richardson Physician heal thyself: are antibiotics the cure or the disease? , 1998, Archives of family medicine.

[58]  D Guillemot,et al.  Inappropriateness and variability of antibiotic prescription among French office-based physicians. , 1998, Journal of clinical epidemiology.

[59]  P. Geslin,et al.  [Development of resistance to beta-lactams and other antibiotics of pneumococci isolated from acute otitis media in France: statement of the National Reference Center 1995-1996]. , 1998, Archives de pediatrie : organe officiel de la Societe francaise de pediatrie.

[60]  D. McClish,et al.  An International Comparison of Physicians' Judgments of Outcome Rates of Cardiac Procedures and Attitudes toward Risk, Uncertainty, Justifiability, and Regret , 1998, Medical decision making : an international journal of the Society for Medical Decision Making.

[61]  A. Mainous,et al.  The cost of antibiotics in treating upper respiratory tract infections in a medicaid population. , 1998, Archives of family medicine.

[62]  Ray W. Cooksey,et al.  Judgment analysis : theory, methods, and applications , 1996 .

[63]  T. Heikkinen,et al.  Signs and symptoms predicting acute otitis media. , 1995, Archives of pediatrics & adolescent medicine.

[64]  M S Gerrity,et al.  Written case simulations: do they predict physicians' behavior? , 1990, Journal of clinical epidemiology.

[65]  F. C. Massey,et al.  The antibiotics. , 1950, The Hahnemannian.