Rita Mangione-Smith1, Jeffrey D Robinson2, Chuan Zhou3, James W Stout4, Alexander G Fiks5, Madeleine Shalowitz6, Jeffrey S Gerber7, Dennis Burges8, Benjamin Hedrick9, Louise Warren10, Robert W Grundmeier11, Matthew P Kronman12, Laura P Shone13, Jennifer Steffes14, Margaret Wright15, John Heritage16. 1. Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA. Electronic address: Rita.M.Mangione-Smith@kp.org. 2. Department of Communication, Portland State University, Portland, OR, USA. Electronic address: jeffreyr@pdx.edu. 3. Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA. Electronic address: Chuan.Zhou@seattlechildrens.org. 4. Department of Pediatrics, University of Washington, Seattle, WA, USA. Electronic address: jstout@u.washington.edu. 5. Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Primary Care Research, American Academy of Pediatrics, IL, USA. Electronic address: fiks@email.chop.edu. 6. Department of Psychiatry and Behavioral Medicine, Rush University School of Medicine, Chicago, IL, USA. Electronic address: Madeleine_Shalowitz@rush.edu. 7. Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA. Electronic address: GERBERJ@email.chop.edu. 8. Department of Pediatrics, University of Washington, Seattle, WA, USA. Electronic address: dburges@uw.edu. 9. Department of Pediatrics, University of Washington, Seattle, WA, USA. Electronic address: bhedrick@uw.edu. 10. Department of Pediatrics, University of Washington, Seattle, WA, USA. Electronic address: lcnovak@uw.edu. 11. Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA. Electronic address: grundmeier@email.chop.edu. 12. Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA. Electronic address: matthew.kronman@seattlechildrens.org. 13. Primary Care Research, American Academy of Pediatrics, IL, USA. Electronic address: lshone@aap.org. 14. Primary Care Research, American Academy of Pediatrics, IL, USA. Electronic address: jsteffes@aap.org. 15. Primary Care Research, American Academy of Pediatrics, IL, USA. Electronic address: mewright@uic.edu. 16. Department of Sociology, University of California Los Angeles, Los Angeles, CA, USA. Electronic address: heritage@ucla.edu.
Abstract
OBJECTIVE: To evaluate receipt fidelity of communication training content included in a multifaceted intervention known to reduce antibiotic over-prescribing for pediatric acute respiratory tract infections (ARTIs), by examining the degree to which clinicians implemented the intended communication behavior changes. METHODS: Parents were surveyed regarding clinician communication behaviors immediately after attending 1026 visits by children 6 months to < 11 years old diagnosed with ARTIs by 53 clinicians in 18 pediatric practices. Communication outcomes analyzed were whether clinicians: (A) provided both a combined (negative + positive) treatment recommendation and a contingency plan (full implementation); (B) provided either a combined treatment recommendation or a contingency plan (partial implementation); or (C) provided neither (no implementation). We used mixed effects multinomial logistic regression to determine whether these 3 communication outcomes changed between baseline and the time periods following each of 3 training modules. RESULTS: After completing the communication training, the adjusted probability of clinicians fully implementing the intended communication behavior changes increased by an absolute 8.1% compared to baseline (95% Confidence Interval [CI]: 2.4%, 13.8%, p = .005). CONCLUSIONS: Our findings support the receipt fidelity of the intervention's communication training content. PRACTICAL IMPLICATIONS: Clinicians can be trained to implement communication behaviors that may aid in reducing antibiotic over-prescribing for ARTIs.
OBJECTIVE: To evaluate receipt fidelity of communication training content included in a multifaceted intervention known to reduce antibiotic over-prescribing for pediatric acute respiratory tract infections (ARTIs), by examining the degree to which clinicians implemented the intended communication behavior changes. METHODS: Parents were surveyed regarding clinician communication behaviors immediately after attending 1026 visits by children 6 months to < 11 years old diagnosed with ARTIs by 53 clinicians in 18 pediatric practices. Communication outcomes analyzed were whether clinicians: (A) provided both a combined (negative + positive) treatment recommendation and a contingency plan (full implementation); (B) provided either a combined treatment recommendation or a contingency plan (partial implementation); or (C) provided neither (no implementation). We used mixed effects multinomial logistic regression to determine whether these 3 communication outcomes changed between baseline and the time periods following each of 3 training modules. RESULTS: After completing the communication training, the adjusted probability of clinicians fully implementing the intended communication behavior changes increased by an absolute 8.1% compared to baseline (95% Confidence Interval [CI]: 2.4%, 13.8%, p = .005). CONCLUSIONS: Our findings support the receipt fidelity of the intervention's communication training content. PRACTICAL IMPLICATIONS: Clinicians can be trained to implement communication behaviors that may aid in reducing antibiotic over-prescribing for ARTIs.
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