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      Association Between Antibiotic Prescribing for Respiratory Tract Infections and Patient Satisfaction in Direct-to-Consumer Telemedicine

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          Abstract

          <p class="first" id="d2002177e291">This study assesses the association between antibiotic prescribing for respiratory tract infections and satisfaction ratings among patients using a direct-to-consumer telemedicine platform. </p>

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          Public beliefs on antibiotics and respiratory tract infections: an internet-based questionnaire study.

          Patient expectations are among the strongest predictors of clinicians' antibiotic prescribing decisions. Although public knowledge, beliefs, and experiences of antibiotics contribute to these expectations, little is known about these public views. To gain insight into public knowledge, beliefs, and experiences of antibiotics and respiratory tract infections. Cross-sectional, internet-based questionnaire study. Members of the general public aged 16 years and over in the Netherlands. Public knowledge, beliefs, and experiences of antibiotics and respiratory tract infections, as well as predictors of accurate knowledge of antibiotic effectiveness, were measured using 20 questions with sub-items. The questionnaire was given to a Dutch community-based nationwide internet panel of 15 673 individuals. Of these, 1248 eligible responders were invited to participate; 935 responders (75%) completed the questionnaire. Of the participants, 44.6% accurately identified antibiotics as being effective against bacteria and not viruses. Acute bronchitis was considered to require treatment with antibiotics by nearly 60% of responders. The perceived need for antibiotics for respiratory tract infection-related symptoms ranged from 6.5% for cough with transparent phlegm, to 46.2% for a cough lasting for more than 2 weeks. Public misconceptions on the effectiveness of, and indications for, antibiotics exist. Nearly half of all responders (47.8%) incorrectly identified antibiotics as being effective in treating viral infections. Doctors should be aware that unnecessary prescribing could facilitate misconceptions regarding antibiotics and respiratory tract infections. Expectations of receiving antibiotics were higher for the disease label 'acute bronchitis' than for any of the separate or combined symptoms prominently present in respiratory tract infection. Public beliefs and expectations should be taken into account when developing interventions targeting the public, patients, and physicians to reduce unnecessary prescribing of antibiotics for respiratory tract infections.
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            Antibiotic prescribing and patient satisfaction in primary care in England: cross-sectional analysis of national patient survey data and prescribing data.

            Concerns about adverse effects on patient satisfaction may be an important obstacle to attempts to curtail antibiotic prescribing.
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              Association of Clinician Denial of Patient Requests With Patient Satisfaction

              Question How is denial of specific types of patient requests during office visits associated with patient satisfaction with the clinician? Findings This was a cross-sectional study of 1141 adults making 1319 office visits to 56 family physicians. Compared with fulfillment of the respective request type, denials of requests for referral, pain medication, other new medication, and laboratory tests were associated with worse patient satisfaction with the clinician. Meaning Denial of some types of requests was associated with worse patient satisfaction with the clinician, but not for others, when compared with fulfillment of the requests, suggesting the need for clinician training in request handling. Importance Prior studies suggesting clinician fulfillment or denial of requests affects patient satisfaction included limited adjustment for patient confounders. The studies also did not examine distinct request types, yet patient expectations and clinician fulfillment or denial might vary among request types. Objective To examine how patient satisfaction with the clinician is associated with clinician denial of distinct types of patient requests, adjusting for patient characteristics. Design, Setting, and Participants Cross-sectional observational study of 1319 outpatient visits to family physicians (n = 56) by 1141 adults at one Northern California academic health center. Main Outcomes and Measures We used 6 Consumer Assessment of Healthcare Providers and Systems Clinician and Group Adult Visit Survey items to measure patient satisfaction with the visit physician. Standardized items were averaged to form the satisfaction score (Cronbach α = 0.80), which was then percentile-transformed. Seven separate linear mixed-effects models examined the adjusted mean differences in patient satisfaction percentile associated with denial of each of the following requests (if present)—referral, pain medication, antibiotic, other new medication, laboratory test, radiology test, or other test—compared with fulfillment of the respective requests. The models adjusted for patient sociodemographics, weight, health status, personality, worry over health, prior visit with clinician, and the other 6 request categories and their dispositions. Results The mean (SD) age of the 1141 patients was 45.6 (16.1) years, and 902 (68.4%) were female. Among 1319 visits, 897 (68.0%) included at least 1 request; 1441 (85.2%) were fulfilled. Requests by category were referral, 294 (21.1%); pain medication, 271 (20.5%); antibiotic, 107 (8.1%); other new medication, 271 (20.5%); laboratory test, 448 (34.0%); radiology test, 153 (11.6%); and other tests, 147 (11.1%). Compared with fulfillment of the respective request type, clinician denials of requests for referral, pain medication, other new medication, and laboratory test were associated with worse satisfaction (adjusted mean percentile differences, −19.75 [95% CI, −30.75 to −8.74], −10.72 [95% CI, −19.66 to −1.78], −20.36 [95% CI, −29.54 to −11.18], and −9.19 [95% CI, −17.50 to −0.87]), respectively. Conclusions and Relevance Clinician denial of some types of requests was associated with worse patient satisfaction with the clinician, but not for others, when compared with fulfillment of the requests. In an era of patient satisfaction-driven compensation, the findings suggest the need to train clinicians to deal effectively with requests, potentially enhancing patient and clinician experiences. This cross-sectional observational study examines how patient satisfaction with the clinician is associated with clinician denial of distinct types of patient requests, adjusting for patient characteristics.
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                Author and article information

                Journal
                JAMA Internal Medicine
                JAMA Intern Med
                American Medical Association (AMA)
                2168-6106
                November 01 2018
                November 01 2018
                : 178
                : 11
                : 1558
                Affiliations
                [1 ]Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio
                [2 ]Department of Family Medicine, Cleveland Clinic, Cleveland, Ohio
                [3 ]Information Technology Division, Cleveland Clinic, Cleveland, Ohio
                [4 ]Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
                [5 ]Office of Patient Experience, Cleveland Clinic, Cleveland, Ohio
                Article
                10.1001/jamainternmed.2018.4318
                6584324
                30285050
                1ffeb69a-b8c4-4e43-910a-92c7b005ed62
                © 2018
                History

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