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October 9, 2018

Give me antibiotics—or else: Patients give harsher reviews to doctors who withhold unnecessary antibiotics

Daily Briefing

    Patients give higher ratings to doctors who virtually prescribe them antibiotics for a common cold, even if antibiotics won't treat their illness, according to a study published Monday in JAMA Internal Medicine.

    Antibiotic overuse kills patients and costs billions. Here's how to cut back.

    Study details

    For the study, researchers looked 8,437 telemedicine appointments between January 2013 and August 2016 through national telemedicine provider Well's Online Care Group.

    The patients, who were being treated for respiratory tract infections, were categorized by prescription outcome: no prescription, prescription of an antibiotic, or prescription of a non-antibiotic medication.

    After their appointments, patients rated their satisfaction with their doctor on a zero-to-five-star scale, with zero indicating the lowest level of satisfaction and five indicating the highest.  

    Patients prefer antibiotics

    Overall, 66% of the study participants were prescribed antibiotics for respiratory tract infections, which in most cases are viral and aren't affected by antibiotics.

    After analyzing the correlation between a physician's mean satisfaction score and the rate at which they prescribe antibiotics, the researchers found that patients were most satisfied with doctors who prescribe antibiotics.

    According to the study, 90% of patients who were prescribed antibiotics rated their physician five stars, compared with 86% of patients who received a non-antibiotic prescription, and 72% of patients who did not receive a prescription.

    "No other patient or physician factor was as strongly associated with patient satisfaction as receipt of a prescription for an antibiotic," the study says.

    The consequences of overprescribing

    Rita Mangione-Smith, the division chief of general pediatrics and hospital medicine at Seattle Children's Research Institute who was not involved with the study, said the results suggest physicians in the study prescribed antibiotics at twice the rate of the prevalence of bacterial infections.

     And overprescribing comes with consequences, she added. "If we keep overprescribing [antibiotics], they will be completely ineffective."

    While overprescribing can cause side effects in patients and contribute to antibiotic resistance, there are a few reasons physicians continue to prescribe drugs unnecessarily, according to Kathryn Martinez, author of the study and internal medicine researcher at the Cleveland Clinic.

    Ratings matter, especially for patients choosing telemedicine services, the study authors said. "Physicians are usually judged based on a percentile of performance," the study noted. "Patients may also distinguish between physicians with 4.7 stars and those with 4.9."

    According to Martinez, the crowdsourced ratings "create an incentive for physicians to do things that are not medically necessary in order to drive up their satisfaction ratings."

    Mangione-Smith said, "Incentives should be about getting the prescribing rate closer to the bacterial prevalence rate."

    Martinez added that physicians might overprescribe antibiotics because it's faster and easier than explaining to patients that they simply don't need them. In fact, a related study, co-authored by Martinez, revealed that physicians save 20 seconds per appointment, or three minutes per day, by prescribing antibiotics(Cohen, NPR "Shots," 10/3; Martinez et al., JAMA Internal Medicine, 10/1).

    Learn more: How to eradicate antibiotic overuse

    Antibiotic-resistant organisms infect some two million Americans each year. To help confront antibiotic overuse, CMS has indicated it will propose that all hospitals must have an antibiotic stewardship program (ASP) in place by 2017 in order to participate in Medicare. Yet many hospitals still lack fully functional ASPs, especially smaller community hospitals where resource limitations present a major barrier.

    Download the slide deck to view case studies and tips from hospitals that have successfully implemented ASPs despite resource challenges.

    Access the Deck & Recording

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