Association between parental satisfaction and antibiotic prescription for children with cough and cold symptoms.

Background: Providers' interest in satisfying parents may provide an impetus for unnecessary antibiotic use in children.

Objectives: To determine (1) whether receipt of antibiotics at a visit for cough and cold symptoms was associated with increased satisfaction and (2) whether nonreceipt of antibiotics at an initial visit but subsequent receipt of antibiotics in the course of the same illness episode was associated with decreased satisfaction.

Methods: Prospective cohort study of patients 2-10 years of age presenting to a university-affiliated pediatric clinic with cough and cold symptoms. Parents were enrolled at the index visit and then followed up by phone at least 7 days later (mean time to follow-up, 14.9 days). Satisfaction with the index visit on a 10 point scale was the primary outcome. The primary predictors were whether antibiotics were prescribed at the index visit and, if not, whether they were prescribed since that visit. Linear and median regression were used to adjust for income, child age, parental race and individual provider.

Results: A total of 539 parents were enrolled in the study, and 378 (70%) completed follow-up interviews. The mean age of participating children was 4.67 years (SD 2.16). Overall 47% of patients received antibiotics at the index visit, and 8% of those that did not reported receiving them between the index visit and the follow-up assessment. In the regression model, receiving antibiotics at the index visit trended toward being associated with higher satisfactions scores (0.28; P = 0.08). Among those who did not receive antibiotics initially, receiving them subsequently was associated with significantly lower median satisfaction score for the index visit (-3.0; P < 0.01).

Conclusions: Receiving antibiotics after an initial visit for cough and cold symptoms at which antibiotics were not prescribed is associated with decreased satisfaction. Use of contingency prescriptions may be an important intervention.