A Scribbled Antibiotic Prescription Can’t Buy Patient Satisfaction

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The notion has been challenged that a patient with an acute respiratory tract infection (URI) won’t go away happy without an antibiotic prescription.

Indeed, a quickly awarded antibiotic prescription for URI patients proved to be an unsatisfactory substitute for spending time with the patient, explaining the condition and treatment, researchers reported here.

To test the perception that URI patients don’t feel properly treated without a prescription, Alexandra Newman, D.V.M, M.P.H., and colleagues at the CDC reviewed patient satisfaction surveys and corresponding pharmacy records from a clinic’s in-house pharmacy.

The team reviewed 1,404 surveys sent out between 1999 and 2003 by the Marshfield Clinic, a regional HMO in Marshfield, Wis. All patients in the study had sought care from a primary care physician for treatment of an acute respiratory tract infection, the CDC team reported here at a meeting of the Infectious Disease Society of America.

Of the patients, 217 adults (45% of 486) and 408 children (49% of 918) received antibiotics. Nonbacterial diagnoses were given for nearly half (46%) the adults and a third (31%) of the children.

The researchers found no correlation between satisfaction (rated on a five point scale) and receipt of an antibiotic prescription among either the adults (p=.19) or the children’s parents (p=0.61).

Moreover, the likelihood of an “excellent” rating in the survey did not increase with antibiotic prescriptions in either group (adults: odd ratio 1.4, 95% confidence interval, 0.8-2.5; parents: OR 1.1 95% CI, 0.8-1.6).

Time spent with the patient, explaining what the physician thought was going on and what they were doing about it, as well as the doctor’s personal manner, were positively associated with an excellent rating for both the adult patients and the parents.

A low response rate of only 31% from the surveys may have introduced a selection bias in the study sample, Dr. Newman cautioned, but added, “We have to work with the tools available.”

Additionally, when the team validated the pharmacy data by comparing it with chart information, they found that a significant number of antibiotic prescriptions were not captured in the original analysis (sensitivity 70%, specificity 96%). Those missing prescriptions may not have been filled, may have been filled outside the HMO system, or the patients may have been given samples, the researchers said.

Primary source: Infectious Disease Society of America Meeting

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