Stivers Tanya, Mangione-Smith Rita, Elliott Marc N, McDonald Laurie, Heritage John
Department of Pediatrics, University of California, Los Angeles 90095-1752, USA.
J Fam Pract. 2003 Feb;52(2):140-8.
To examine the relation between parent expectations for antibiotics, parent communication behaviors, and physicians' perceptions of parent expectations for antibiotics.
A nested cross-sectional study with parallel measures of parents presenting children for acute respiratory infections (previsit) and physicians (postvisit) and audiotaping of the encounters.
Ten physicians in 2 private pediatric practices (1 community-based and 1 university-based) and a consecutive sample of 306 eligible parents (response rate, 86%) who were attending sick visits for their children between October 1996 and March 1997.
Communication behaviors used by parents expecting antibiotics and physicians' perceptions of parents' expectations.
Parents' use of "candidate diagnoses" during problem presentation increased the likelihood that physicians would perceive parents as expecting antibiotics (from 29% to 47%; P=.04), as did parents' use of "resistance to the diagnosis" (an increase from 7% to 20%). In the multivariate model, parents' use of candidate diagnoses increased the odds that a doctor would perceive a parental expectation for antibiotics by more than 5 times (odds ratio, 5.23; 95% confidence interval, 3.74-7.31; Plt.001), and parents' use of resistance to a viral diagnosis increased these odds by nearly 3 times (odds ratio, 2.73; 95% confidence interval, 1.97-3.79; Plt.001).
Parents perceived as expecting antibiotics may be seeking reassurance that their child is not seriously ill or that they were correct to obtain medical care. Physicians were significantly more likely to perceive parents as expecting antibiotics if they used certain communication behaviors. This study revealed an incongruity between parents' reported expectations, their communication behaviors, and physicians' perceptions of parents' expectations.
探讨家长对抗生素的期望、家长的沟通行为以及医生对家长对抗生素期望的认知之间的关系。
一项嵌套横断面研究，对带孩子前来治疗急性呼吸道感染的家长（就诊前）和医生（就诊后）进行平行测量，并对诊疗过程进行录音。
两家私立儿科诊所（一家社区诊所和一家大学诊所）的10名医生，以及1996年10月至1997年3月期间为孩子进行 sick 就诊的306名符合条件的家长的连续样本（应答率为86%）。
期望使用抗生素的家长所采用的沟通行为以及医生对家长期望的认知。
家长在陈述问题时使用“候选诊断”会增加医生认为家长期望使用抗生素的可能性（从29%增至47%；P = 0.04），家长使用“对诊断的抵触”时也是如此（从7%增至20%）。在多变量模型中，家长使用候选诊断会使医生认为家长期望使用抗生素的几率增加5倍多（优势比为5.23；95%置信区间为3.74 - 7.31；P < 0.001），家长对病毒诊断的抵触会使这些几率增加近3倍（优势比为2.73；95%置信区间为1.97 - 3.79；P < 0.001）。
被认为期望使用抗生素的家长可能是在寻求孩子病情不严重或就医正确的安心感。如果家长使用某些沟通行为，医生更有可能认为家长期望使用抗生素。本研究揭示了家长报告的期望、他们的沟通行为以及医生对家长期望的认知之间存在不一致。
