Reducing unwarranted antibiotic use for pediatric acute otitis media: the influence of physicians' explanation and instruction on parent compliance with ‘watchful waiting’

ABSTRACT

‘Watchful waiting’ (WW) involves prescribing antibiotics but advising against use unless the illness fails to improve in a set time. For childhood ear infections, WW can reduce unnecessary antibiotic use, but parents do not necessarily comply with WW advice. This study examines how physician explanation and instruction is related to parental compliance. A national sample of parents (N = 134) who received WW advice reported what they remembered physicians saying. These responses were coded for explanatory and instructional elements indicated by relevant clinical guidelines. Parents also reported whether they complied with the WW advice or administered the antibiotic immediately. Parental compliance was predicted by explanation of the nature of ear infections, instruction on monitoring, and instruction on managing pain. Few parents reported any explanation about antibiotics’ adverse effects. Findings suggest physicians can improve parent compliance with WW by improving the quality of the explanation and instruction they provide.

KEYWORDS:

• Watchful waiting
• antibiotic stewardship
• medical advice
• acute otitis media

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Erina L. MacGeorge http://orcid.org/0000-0003-0534-6038

Rachel A. Smith http://orcid.org/0000-0003-2407-7515

Notes

1. Some forms of watchful waiting put greater restriction on access to antibiotics, such as a waiting period without a prescription, with a follow-up call or visit required to substantiate a worsening condition before the prescription is given. Herein, we focus principally on the less restrictive form since it is represented in the AAP guidelines (Lieberthal et al., 2013) as the typical approach, and because giving caregivers control of the antibiotic prescription makes communication from health care providers a more critical influence on whether antibiotics are used.

2. We explored whether the principal variables and relationships of interest differed by the demographic variables we assessed. Although there were some demographic differences in recalled instructions and compliance, none of the demographic variables moderated the observed relationships between instructions and compliance, and so these analyses are not reported. Additional detail is available from the first author.

Additional information

Funding

This work was supported by the Centers for Disease Control and Prevention through a cooperative agreement CDC-RFA-CK141401PPHF14. The content is solely the responsibility of the authors and does not necessarily represent the views of the funding agency.