Knowledge and beliefs of primary care physicians, pharmacists, and parents on antibiotic use for the pediatric common cold
Introduction
Korea has had compulsory medical insurance with universal coverage of the population since 1989. People freely choose among family physicians, specialists, and even outpatient departments of hospitals. All medical services are reimbursed on a fee-for-service basis and patients pay a small amount out-of-pocket (about 3 US Dollars) when they visit a clinic. Korea introduced a policy to segregate the roles of physicians and pharmacists in July 2000. Before that time, pharmacists could dispense medicine, including antibiotics without physician prescription.
The pediatric common cold is a leading cause of office visits to physicians in Korea (National Health Insurance Corporation, 2001). Antimicrobial resistance is a major public health issue, in that 86% of Streptococcus pneumoniae is now resistant to penicillin in Korea (Lee et al., 2001). The antibiotic prescription rate for the pediatric common cold is 90.6%, based on insurance claim data in Korea (Park & Moon, 1998), which is much higher than that of other countries. The relevant antibiotic prescription rate is 44% in the USA (Nyquist, Gonzales, Steiner, & Sande, 1998) and 17% in the Netherlands for encounters with the acute upper respiratory infection (de Melke & Kuyvenhoven, 1994). As there is clear evidence that the increased resistance is associated with recent antibiotic overuse (Arason et al., 1996), this overuse should be reduced to a minimum.
Several factors have been suggested as associated with the prescription of antibiotics for the common cold. Palmer summarized these as parental demand, time constraints, and concerns about malpractice and litigation (Palmer & Baucher, 1997). In addition, she thought the physician’s perception of patient expectations is a much more important predictor than patient expectation itself, though one study suggested that these perceptions are the only significant predictor of prescribing antibiotic for viral illness (Mangione-Smith, McGlynn, Elliot, Krogstad, & Brook, 1999). When physicians are pressured to see many patients, writing a prescription is perceived as more time-efficient than explaining the natural course of an upper respiratory infection (Schwartz, Mainous, & Marcy, 1998). Concern for malpractice and litigation may also be associated with antibiotic prescription.
As the antibiotic prescription rate for the pediatric common cold in Korea is much higher than in other countries (Kim et al., 2000), there may be more specific or stronger factors in Korea. Parental demand for antibiotics may not be the most important factor, since the power relationship between physicians and parents is not equal. The fact that, in Korea, only one quarter of parents have been reported as being have given an explanation about disease by their physicians, and approximately 20% of parents have reported questioning the doctor about whether the prescription contained antibiotics or not (Park, Kim, Kim, & Kim, 2001), suggests imbalance in power between physicians and parents. In addition, physicians’ level of knowledge is one of the most important reasons for inappropriate prescribing (Lexchin, 1998), and the knowledge and beliefs of Korean health care providers about antibiotics may be different from those in other countries.
Korea introduced a policy of segregating the role of physicians and pharmacists in July 2000. Before the policy was introduced, pharmacists could dispense antibiotics without a physicians’ prescription, creating competition between physicians and pharmacists in addition to competition among physicians themselves. As Korea does not have a registration system similar to general practise in the UK, and only half of patients have a regular source of care (Cho, Shim, Lee, & Lee, 2001), patients choose physicians freely. “Doctor shopping” is very prevalent and competition among physicians is strong. Despite pharmacists’ loss of discretionary power to prescribe antibiotics, they still maintain a strong influence on antibiotic use due to their accessibility to patients.
The objectives of this study are to compare the knowledge and beliefs of primary care physicians, pharmacists, and parents concerning the effect of antibiotics on the pediatric common cold, and to investigate the possible factors related to the high antibiotic prescription rate for the pediatric common cold in Korea. Because to survey patients who visited doctors’ offices might bias the result, it was necessary to base our study on a sample of the general population.
Section snippets
Methods
A simple random sample of 600 physicians (300 from each specialty) was taken from the Health Insurance Corporation Health Care Organization file, containing 1995 family physicians and 2857 pediatricians who were working in clinic. Sample size was decided by a power calculation on the categorical variables, 5% significance level. This indicated a minimum of 152 physicians in each group, with a response rate of 70%. It was decided to start with samples of 300 physicians in each group.
The
Results
The demographic characteristics of the study subjects are shown in Table 1, Table 2. Most primary care physicians were male, practising solo in urban areas, and saw approximately 80 patients in a usual day. Compared with the physicians, the majority of the pharmacists were female. They worked more often in a group, worked predominantly in urban areas, and dispensed more than 100 prescriptions a day. Almost all responding parents were female, living in urban area and about half of them visited a
Discussion
This is the first report to compare the knowledge and beliefs of physicians, pharmacists, and parents on antibiotic use for the pediatric common cold. We tried to obtain representative samples of primary care physicians, pharmacists, and parents and to obtain a good response rate to assure the validity of the study. Responding parents were predominantly female, but the usual caregivers in Korea are women.
Knowledge and beliefs of physicians and pharmacists in Korea are very different from those
Acknowledgements
I would like to thank Dr. Jee-Young Pak, Dr. Anita K. Wagner and Dr. Lisa Pfeiffer for revising English on an earlier version of this paper.
References (35)
- et al.
Antibiotic use and upper respiratory infectionsA survey of knowledge, attitudes, and experience in Wisconsin and Minnesota
Preventive Medicine
(2002) - et al.
Families who seek care for the common cold in a pediatric emergency department
Journal of Pediatrics
(1991) Participating in decisions about treatmentOvert parent pressure for antibiotic medication in pediatric encounters
Social Science & Medicine
(2002)- et al.
Do antimicrobials increase the carriage rate of penicillin resistant pneumococci in children? Cross sectional prevalence study
British Medical Journal
(1996) - et al.
Current attitudes regarding use of antimicrobial agentsResults from physician’s and parents’ focus group discussions
Clinical Pediatrics
(1998) Patient’s demands for prescriptions in primary care
British Medical Journal
(1995)- et al.
The influence of patients’ hopes of receiving a prescription on doctors’ perceptions and decision to prescribeA questionnaire survey
British Medical Journal
(1997) - et al.
Antibiotics and shared decision-making in primary care
Journal of Antimicrobial Chemotherapy
(2001) - et al.
Understanding the culture of prescribingQualitative study of general practitioners’ and patients’ perceptions of antibiotics for sore throat
British Medical Journal
(1998) What do patients expect from consultations for upper respiratory tract infections?
Family Practice
(1996)
Factors associated with possession of regular doctor in Korea
Journal of Korean Academy of Family Medicine
Prescribing behaviour in clinical practice: Patients’ expectations and doctors’ perceptions of patients’ expectationsA questionnaire study
British Medical Journal
Parents knowledge about common respiratory infections and antibiotic therapy in children
Southern Medical Journal
Management of upper respiratory tract infections in Dutch family practice
Journal of Family Practice
Potential interventions for preventing pneumonia among young childrenLack of effect of antibiotic treatment for upper respiratory infections
Pediatric Infectious Disease Journal
Impact of reducing antibiotic prescribing for acute bronchitis on patient satisfaction
Effective Clinical Practice
Antibiotics and respiratory infectionsAre patients more satisfied when expectations are met?
Journal of Family Practice
Cited by (84)
Antibiotic prescription for acute upper respiratory tract infections: Understanding patient and physician contributions via patients’ migration
2022, Social Science and MedicineCitation Excerpt :A survey of physicians and parents related to the common pediatric cold in Korea reports that 73.3% of physicians believe that parents expect antibiotics to be prescribed for their children (Cho et al., 2004). Further, 43.8% of physicians prescribe antibiotics when this is requested by patients, even when they believe it is unnecessary (Cho et al., 2004). However, only a small fraction of parents ask for antibiotics explicitly (2.2%).
The dentist's first turn-at-talk in Korean dental visits
2021, Journal of PragmaticsA scoping review on the influential cognitive constructs informing public AMR behavior compliance and the attribution of personal responsibility
2020, American Journal of Infection ControlCitation Excerpt :Following the Arksey and O'Malley framework,18 43 studies were selected for review based on the research questions and 3 themes were identified: sociodemographic influences; knowledge, misconceptions, and fallacies; and, public attitudes and the social influence of friends and family. Analysis of the literature identified knowledge,7,8,11,29-59 beliefs,7,8,44,55,56 attitudes,11,20,28,29,43-45,53,55 and social norms20,23,28,31,33,34,44,47 as cognitive constructs which influence public AMR behavior compliance. The results of this research support the findings of previous studies10,11,15-17 that suggest various cognitive constructs contribute toward informing public AMR behavior.
When more is less: What explains the overuse of health care services in China?
2019, Social Science and Medicine