Low-value antibiotic prescribing and clinical factors influencing patient satisfaction.

OBJECTIVES

Patient-centered healthcare is a high priority and is commonly measured and incentivized through patient satisfaction surveys. There is a need to further understand if increasing satisfaction has the unintended consequence of encouraging low-value care. This study assessed the association of low-value antibiotic prescribing with patient satisfaction scores, and it evaluated patient and provider characteristics that may impact the association.

STUDY DESIGN

Retrospective, observational study of acute sinusitis (AS) encounters for adult members of a large integrated delivery system from 2010 to 2013.

METHODS

Bivariate and multivariate analyses evaluating the use of antibiotics, patient attributes, and provider characteristics associated with favorable patient satisfaction scores.

RESULTS

Among 5169 encounters for AS, 79.5% of encounters in which antibiotics were prescribed had favorable satisfaction scores versus 75.4% of encounters in which they were not. Independent predictors of favorable satisfaction scores included: receipt of antibiotics (adjusted odds ratio [aOR], 1.24; 95% CI, 1.00-1.55), 45 years or older (aOR, 1.45; 95% CI, 1.24-1.69), Elixhauser Comorbidity Index score 2 or greater (aOR, 1.21; 95% CI, 1.05-1.40), provider business partner status (aOR, 1.38; 95% CI, 1.20-1.58), and a bonded encounter between a patient and their assigned primary care physician (aOR, 2.06; 95% CI, 1.75-2.44).

CONCLUSIONS

Patient satisfaction scores are slightly lower when antibiotics are not prescribed for AS, but 75% of those encounters still received favorable satisfaction scores. Factors such as older patient age, more comorbidities, and an established patient-provider relationship had stronger associations with high patient satisfaction.