Summaries of Independent Scientist (K) Awards

Mangione-Smith, Rita

Institution:  University of Washington, Seattle
Grant Title: Doctor-Parent Communication and Antibiotic Over-Prescribing
Grant Number: K02 HS013299
Duration: 5 years (2002-2007)

Total Award: $473,850

Project Description: This project has five main goals:

1. To explore what systematic communication behaviors parents use to express their desires for antibiotic prescriptions.
2. To examine what parent communication behaviors lead to both accurate and inaccurate physician perceptions of parental expectations of antibiotics.
3. To determine if physician perceptions of parent expectations are associated with antibiotic prescribing for viral conditions and higher rates of assigning bacterial diagnoses to upper respiratory infections.
4. To determine if specific physician communication behaviors are associated with increased parental satisfaction when expectations for unnecessary antibiotics are not fulfilled.
5. To develop and test a communication-based intervention to decrease inappropriate antibiotic prescribing in the pediatric outpatient setting.

Career Goals:  Dr. Mangione-Smith's main career goals are to continue to expand what is known about pediatric quality of care assessment and improvement and to translate this knowledge into practice.

Progress to Date:  Combined analyses of survey and communication data from 543 physician-parent encounters is complete. Dr. Mangione-Smith and colleagues found a large degree of variation in parent expectations for antibiotics among various racial/ethnic groups of parents, with expectations being greatest for Latinos and Asians. However, these higher expectations did not translate into different communication patterns for these groups of parents. The communication analysis results suggest that focusing treatment recommendations on what can be done to make a child feel better rather than on what is not needed—i.e., antibiotics, increases both acceptance of non-antibiotic treatment recommendations and satisfaction with care. A manuscript based on these findings is in press at Archives of Pediatrics and Adolescent Medicine. Dr. Mangione-Smith and colleagues have developed an interactive communication-based intervention workshop for physicians based on these findings.

Future Plans: Two manuscripts based on additional analyses of the data are in preparation. Dr. Mangione-Smith is also in the process of applying for R21 funding to pilot test the intervention workshop with physicians who are members of the Puget Sound Pediatric Research Network (PSPRN). The PSPRN is a well established practice-based research network in the Seattle, WA area. After pilot testing and refinement of the intervention workshop, Dr. Mangione-Smith will apply for RO1 funding to conduct a randomized controlled trial of the intervention in the Pediatric Research in Office Settings (PROS) network. PROS is a national practice-based research network that includes practitioners from all 50 states.

Highlights and Specific Accomplishments:

• 8/2005-Present, Associate Professor of Pediatrics, University of Washington, Seattle, WA.
• 7/2005-8/2005, Associate Professor of Pediatrics, University of California, Los Angeles
• Pediatric Research Consultant, Health Program, RAND.
• Professional Societies:
  • Ambulatory Pediatric Association.
  • Academy for Health Services Research and Health Policy.
  • Society for Pediatric Research.
• 2003 Award for Distinguished Service, U.S. Department of Health and Human Services, in recognition for outstanding contribution to improving public health through the development of quality performance measures for antibiotic prescribing for respiratory tract infections.

K-Generated Publications:

• Mangione-Smith R, Elliott MN, Stivers T, et al. Ruling out the need for antibiotics: are we sending the right message? Archives of Pediatrics and Adolescent Medicine. In Press.
• Mangione-Smith R, Elliott MN, Stivers T, et al. Racial/Ethnic Variation in Parent Expectations for Antibiotics: Implications for Public Health Campaigns. Pediatrics 2004;113(5):e385-94.
• Mangione-Smith R, Stivers T, Elliott M, et al. Online Commentary During the Physical Examination: A Communication Tool for Avoiding Inappropriate Antibiotic Prescribing? Social Science & Medicine 2003;56:313-20.
• Stivers T, Mangione-Smith R, Elliott MN, et al. Why do Physicians Think Parents Expect Antibiotics? What Parents Report vs What Physicians Believe. Journal of Family Practice 2003;2(52):140-8.

AHRQ Research Portfolio:  Care Management; Training; Quality and Patient Safety.
AHRQ Goals:  Effectiveness

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