{"id":8914,"date":"2018-10-15T13:00:13","date_gmt":"2018-10-15T17:00:13","guid":{"rendered":"https:\/\/blogs.nejm.org\/hiv-id-observations\/?p=8914"},"modified":"2018-10-15T14:28:18","modified_gmt":"2018-10-15T18:28:18","slug":"outpatient-antibiotic-prescribing-boosts-patient-satisfaction-scores-rewarding-bad-medical-practice","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/outpatient-antibiotic-prescribing-boosts-patient-satisfaction-scores-rewarding-bad-medical-practice\/2018\/10\/15\/","title":{"rendered":"Outpatient Antibiotic Prescribing Boosts Patient Satisfaction Scores, Rewarding Bad Medical Practice"},"content":{"rendered":"

A recent study<\/a> confirms what every busy clinician already knows.<\/p>\n

Many patients seeking care for respiratory infections expect to receive an antibiotic. When they get one, they’re happier than if they don’t.<\/em><\/p>\n

Among 8437 patients seeking care for a respiratory tract infection in a direct-to-consumer telemedicine service, 66% received an antibiotic. The rate of prescriptions prescribed by physicians ranged from 19% to 90%, showing that these were not exactly evidence-based decisions. Satisfaction ratings strongly correlated with adjusted antibiotic prescribing rates (Pearson correlation, 0.41; P<\/em>\u2009<\u2009.001).<\/p>\n

It’s even worse if you look at the figure — none<\/em> of the MDs in the lowest half of prescribers exceeded the 75th percentile for patient satisfaction.<\/p>\n

More details:<\/p>\n

Few physicians achieved even the 50th percentile of satisfaction while maintaining low rates of antibiotic prescribing. To reach the top quartile, a physician had to prescribe antibiotics at least half the time; almost all physicians above the 90th percentile had a rate of antibiotic prescribing greater than 75%.<\/p><\/blockquote>\n

This isn’t the first time we’ve seen data like these. In this earlier study<\/a> comparing immediate versus deferred versus no antibiotic (along with a patient education intervention), patients with the immediate antibiotic prescription were significantly more likely to be very satisfied with their care — even though clinical outcomes were, not surprisingly, the same.<\/p>\n

Jeffrey Linder — who studies appropriate outpatient antibiotic prescribing — would no doubt remind me that not every<\/em> study demonstrates this effect of antibiotic prescribing and increased patient satisfaction. While this is true, his group just presented data<\/a> that many antibiotic prescriptions aren’t written in the context of a patient visit, and often for diagnoses not even related to infection.<\/p>\n

I asked a physician who works with one of the companies charged with assessing patient satisfaction what he thought about these recent survey data. He made the excellent point that it was physician communication — time spent talking with patients — that most powerfully drove patient satisfaction.<\/p>\n

While no doubt this is true, let’s imagine you control for this talk-time. And that clinicians in urgent care centers and telemedicine systems are graded on volume (productivity) and patient satisfaction scores. Some would undoubtedly consider the counseling and education piece too time consuming. Remember, it was urgent care centers that had the highest rate of inappropriate antibiotic prescribing in a study published earlier this year.<\/a><\/p>\n

What’s the fastest way for urgent care and telemedicine clinicians to achieve higher scores in patient satisfaction and “see” more patients\/hour? In our action-driven society,\u00a0 it’s doing “something” (antibiotics, pain relievers, sleep aids, MRIs, you name it) rather than “nothing” (observation). It takes energy and time to explain why the latter is often the right choice.<\/p>\n

If you doubt my ID-doctor biased perspective, here’s another interesting view<\/a> on this study from F. Perry Wilson on Medscape:<\/em><\/p>\n

\"\"<\/a><\/p>\n

All of this\u00a0 leads to an all-too-familiar patient encounter, typified by this note from a local walk-in center:<\/p>\n

\"\"<\/a><\/p>\n

Finally, could anything comment more appropriately on this relationship between antibiotics and patient satisfaction than this New Yorker<\/em> cartoon?<\/a><\/p>\n

So what are we going to do about it?<\/p>\n","protected":false},"excerpt":{"rendered":"

A recent study confirms what every busy clinician already knows. Many patients seeking care for respiratory infections expect to receive an antibiotic. When they get one, they’re happier than if they don’t. Among 8437 patients seeking care for a respiratory tract infection in a direct-to-consumer telemedicine service, 66% received an antibiotic. The rate of prescriptions […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,5,8,10],"tags":[],"class_list":["post-8914","post","type-post","status-publish","format-standard","hentry","category-health-care","category-infectious-diseases","category-patient-care","category-research"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/8914","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=8914"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/8914\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=8914"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=8914"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=8914"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}