Clinical, social and relational determinants of paediatric ambulatory drug prescriptions due to respiratory tract infections in Italy

Abstract

Objectives

Collecting information on patterns of drug prescriptions and on factors influencing prescribing decisions is fundamental for supporting the rational use of drugs. This study was aimed at investigating patterns of drug prescription in paediatric outpatients and at evaluating determinants of prescriptions for respiratory tract infections (RTIs).

Methods

We conducted a national cross-sectional survey involving primary care paediatricians and parents. Diagnoses and prescriptions made at each consultation were described. Poisson regression models were used to analyse determinants of drug and antibiotic prescriptions for visits due to RTIs.

Results

A total of 4,302 physician and parent questionnaires were analysed. These corresponded to 2,151 visits, 792 of which were due to RTIs. Drugs were prescribed in 83.4% of RTI visits, while antibiotics were prescribed in 40.4%. According to paediatricians’ perceptions, 84.2% of parents of children with a RTI expected to receive a drug prescription. Paediatricians’ perception of parental expectations was the strongest determinant for prescription of drugs and specifically of antibiotics [adjusted relative risk (RR): 1.7 and 3.6, respectively; P < 0.001]. However, in 77.1% of RTI visits, paediatricians judged themselves as not being influenced at all by parents’ expectations in their decision to prescribe.

Conclusions

This study underscores that relational factors, in particular perceived parental expectations, are one of the leading factors of drug prescriptions in paediatric ambulatory care settings, reinforcing the opinion that communication between physicians and parents can affect prescription patterns.

Appendix

Paediatrician questionnaire variables

Paediatrician code:_ _ _

First three letters of patient’s name:_ _ _

First three letters of patient’s surname:_ _ _

Sex: ❑ M ❑ F

Age: _ _ _ years _ _ _ months (only if child is <1 year of age)

Date of consultation:_ _/_ _ /_ _ _ _

How long did the consultation last?

❑ Less than 15 min

❑ 15–30 min

❑ Over 30 min

Had this visit been scheduled for:

❑ Well child care consultation

❑ Vaccination for _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

❑ Other

Main diagnosis:

❑ Acute otitis media

❑ Other upper respiratory tract infection

❑ Lower respiratory tract infection

❑ Gastroenteritis

❑ Other disorder of the gastrointestinal tract

❑ Asthma or other respiratory disease with bronchospasm

❑ Allergic disorders other than asthma

❑ Skin disorder

❑ Endocrinopathy

❑ Trauma/accident

❑ Blood disorder

❑ Insomnia or other sleep disorder

❑ Behaviour disorder

❑ Fever of unknown origin

❑ Other infectious or parasitic disease (specify) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

❑ Non-classified signs/symptoms (specify) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

❑ Other (specify) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

❑ Follow-up visit (specify) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Did the child have fever at the time of consultation?

❑ Yes

❑ No

❑ Don’t know

The main diagnosis was made on the basis of:

❑ Clinical features

❑ Clinical features plus laboratory findings and/or other exams

If the diagnosis was made solely on the basis of the clinical picture, were other tests requested to confirm the diagnosis?

❑ Yes

❑ No

If YES, which of the following were requested:

❑ Specialist consultation

❑ Follow-up examination

❑ Laboratory tests

❑ Other tests

Was the child seen by yourself or by a colleague in the last month for the same disorder?

❑ Yes

❑ No

❑ Don’t know

At the time of the visit was the child already taking any medicine/s for this disorder (including topical preparations, vitamins, homeopathic remedies, supplements or other non-conventional remedies)?

❑ Yes

❑ No

❑ Don’t know

If YES, specify commercial name/s_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

If YES, had the medications been:

❑ Prescribed by yourself

❑ Prescribed by another physician

❑ Recommended by a pharmacist

❑ Self-prescribed

❑ Don’t know

Were any medications prescribed during the consultation (including topical preparations, vitamins, homeopathic remedies, supplements or other non-conventional remedies)?

❑ Yes

❑ No

If YES, for each medicine indicate the commercial name:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

With respect to the child’s current illness, the person accompanying the child was:

❑ Overly worried

❑ Justly worried

❑ Not adequately worried

In your opinion, how much did the person accompanying the child expect to receive a drug prescription?

❑ Very much

❑ Slightly

❑ Not at all

❑ Don’t know

In your opinion, how much, if at all, did the expectations of the person accompanying the child influence your choice of whether or not to prescribe a medicine?

❑ Very much

❑ Slightly

❑ Not at all

❑ Don’t know

Did the person accompanying the child suggest or explicitly ask you to prescribe a medicine/s?

❑ Yes

❑ No

Are you satisfied with the amount of time you allotted to the consultation?

❑ Yes, completely satisfied

❑ Sufficiently satisfied

❑ No, not satisfied

Parent questionnaire variables

Data regarding the child’s mother

Age (years): _ _ _

Nationality:

❑ Italian

❑ Other (specify) _ _ _ _ _ _ _ _ _ _ _ _ _ _

Educational level:

❑ Primary school (grades 1–5)

❑ Middle school (grades 6–8)

❑ High school (grades 9–13)

❑ University

Current work position:

❑ Does not work, stays at home

❑ Professional woman, manager, entrepreneur

❑ Office worker/teacher

❑ Skilled/unskilled worker/craftswoman

❑ Other (specify) _ _ _ _ _ _ _ _ _ _ _ _ _ _

Data regarding the child’s father

Age (years): _ _ _

Nationality:

❑ Italian

❑ Other (specify) _ _ _ _ _ _ _ _ _ _ _ _ _ _

Educational level:

❑ Primary school (grades 1–5)

❑ Middle school (grades 6–8)

❑ High school (grades 9–13)

❑ University

Current work position:

❑ Does not work, stays at home

❑ Professional man, manager, entrepreneur

❑ Office worker/teacher

❑ Skilled/unskilled worker/craftsman

❑ Other (specify) _ _ _ _ _ _ _ _ _ _ _ _ _ _

Data regarding the child

First three letters of child’s name: _ _ _

First three letters of child’s surname: _ _ _

Sex: ❑ M ❑ F

Date of birth: _ _/_ _ /_ _ _ _

Has the child any siblings?

❑ Yes

❑ No

If YES, how many?

❑ 1

❑ 2

❑ 3 or more

If YES, is the child a:

❑ First child

❑ Second child

❑ Third child or over

If the child is below 6 years of age indicate if he/she goes to day care or nursery school:

❑ Yes

❑ No

The person accompanying the child to the consultation is the child’s

❑ Mother

❑ Father

❑ Other (specify) _ _ _ _ _ _ _ _ _ _ _ _ _ _

Would you define your child’s clinical condition as being:

❑ Very worrisome

❑ Moderately worrisome

❑ Not worrisome

In your opinion, in order to resolve your child’s medical problem, a medicine is:

❑ Definitely necessary

❑ Probably necessary

❑ Probably not necessary

❑ Don’t know

To be completed only AFTER the medical examination:

In your opinion, the amount of time spent by the paediatrician for the consultation was:

❑ Good

❑ Sufficient

❑ Inadequate

Overall, are you satisfied with the consultation?

❑ Yes, very satisfied

❑ Yes, fairly satisfied

❑ No

Following the medical consultation, would you consider your child’s health status to be:

❑ Very worrisome

❑ Moderately worrisome

❑ Not worrisome

During the consultation did you ask the doctor to prescribe specific medicines for your child?

❑ Yes

❑ No

If YES, which medicine(s) did you request? _ _ _ _ _ _ _ _ _ _ _ _ _ _