Randomized controlled trial of parent therapeutic education on antibiotics to improve parent satisfaction and attitudes in a pediatric emergency department

François Angoulvant, Anne Rouault, Sonia Prot-Labarthe, Priscilla Boizeau, David Skurnik, Laurence Morin, Jean-Christophe Mercier, Corinne Alberti, Olivier Bourdon, François Angoulvant, Anne Rouault, Sonia Prot-Labarthe, Priscilla Boizeau, David Skurnik, Laurence Morin, Jean-Christophe Mercier, Corinne Alberti, Olivier Bourdon

Abstract

Objective: To evaluate therapeutic education delivered in a pediatric emergency department to improve parents' satisfaction and attitudes about judicious antibiotic use.

Methods: In an emergency department of a tertiary pediatric hospital, children aged 1 month to 6 years and discharged with an oral antibiotic prescription for an acute respiratory or urinary tract infection were randomized to a patient therapeutic education on antibiotic use (intervention group) or fever control (control group) delivered to the parents (in the presence of the children) by a pharmacist trained in therapeutic education. Education consisted in a 30-minute face-to-face session with four components: educational diagnosis, educational contract, education, and evaluation. The main outcome measure was parent satisfaction about information on antibiotics received at the hospital, as assessed by a telephone interview on day 14. The secondary outcome was attitudes about antibiotic use evaluated on day 14 and at month 6.

Results: Of the 300 randomized children, 150 per arm, 259 were evaluated on day 14. Parent satisfaction with information on antibiotics was higher in the intervention group (125/129, 96.9%, versus 108/130, 83.0%; P=0.002, exact Fisher test).

Intervention: Group parents had higher proportions of correct answers on day 14 to questions on attitudes about judicious antibiotic use than did control-group parents (P=0.017, Mann-Whitney U test).

Conclusion: Therapeutic education delivered by a clinical pharmacist in the pediatric emergency department holds promise for improving the use of antibiotics prescribed to pediatric outpatients.

Trial registration: ClinicalTrials.gov NCT00948779 https://ichgcp.net/clinical-trials-registry/NCT00948779.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Participant flow chart.
Figure 1. Participant flow chart.
Figure 2. Percentage of correct answers about…
Figure 2. Percentage of correct answers about judicious antibiotic use at the first assessment on day 14.
The numbers on top of the bars are the absolute numbers of parents who gave correct answers on day 14.
Figure 3. Percentage of correct answers about…
Figure 3. Percentage of correct answers about judicious antibiotic use at the second assessment at month 6.
The numbers on top of the bars are the absolute numbers of parents who gave correct answers at month 6.

References

    1. Spellberg B, Guidos R, Gilbert D, Bradley J, Boucher HW et al. (2008) The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America. Clin Infect Dis 46: 155-164. doi:. PubMed: .
    1. van de Sande-Bruinsma N, Grundmann H, Verloo D, Tiemersma E, Monen J et al. (2008) Antimicrobial drug use and resistance in Europe. Emerg Infect Dis 14: 1722-1730. doi:. PubMed: .
    1. Dowell SF, Schwartz B (1997) Resistant pneumococci: protecting patients through judicious use of antibiotics. Am Fam Physician 55: 1647-1658. PubMed: .
    1. Lieberman JM (2003) Appropriate antibiotic use and why it is important: the challenges of bacterial resistance. Pediatr Infect Dis J 22: 1143-1151. doi:. PubMed: .
    1. Dajani AS (1996) Adherence to physicians’ instructions as a factor in managing streptococcal pharyngitis. Pediatrics 97: 976-980. PubMed: .
    1. Kardas P, Devine S, Golembesky A, Roberts C (2005) A systematic review and meta-analysis of misuse of antibiotic therapies in the community. Int J Antimicrob Agents 26: 106-113. doi:. PubMed: .
    1. Grijalva CG, Nuorti JP, Griffin MR (2009) Antibiotic prescription rates for acute respiratory tract infections in US ambulatory settings. JAMA 302: 758-766. doi:. PubMed: .
    1. Gonzales R, Malone DC, Maselli JH, Sande MA (2001) Excessive antibiotic use for acute respiratory infections in the United States. Clin Infect Dis 33: 757-762. doi:. PubMed: .
    1. Dommergues MA, Hentgen V (2012) Decreased paediatric antibiotic consumption in France between 2000 and 2010. Scand J Infect Dis 44: 495-501. doi:. PubMed: .
    1. Finkelstein JA, Davis RL, Dowell SF, Metlay JP, Soumerai SB et al. (2001) Reducing antibiotic use in children: a randomized trial in 12 practices. Pediatrics 108: 1-7. doi:. PubMed: .
    1. Dagan R, Lepage P (2009) Introduction: childhood respiratory diseases: management in an era of antibiotic resistance. Pediatr Infect Dis J 28: S119-S120. doi:. PubMed: .
    1. Otters HB, van der Wouden JC, Schellevis FG, van Suijlekom-Smit LW, Koes BW (2004) Trends in prescribing antibiotics for children in Dutch general practice. J Antimicrob Chemother 53: 361-366. doi:. PubMed: .
    1. Schindler C, Krappweis J, Morgenstern I, Kirch W (2003) Prescriptions of systemic antibiotics for children in Germany aged between 0 and 6 years. Pharmacoepidemiol Drug Saf 12: 113-120. doi:. PubMed: .
    1. Price EL, Mackenzie TD, Metlay JP, Camargo CA Jr., Gonzales R (2011) A computerized education module improves patient knowledge and attitudes about appropriate antibiotic use for acute respiratory tract infections. Patient Educ Couns 85: 493-498. doi:. PubMed: .
    1. World Health Organization (2001) WHO Global strategy for the containment of antimicrobial resistance. Available: . Accessed 1 March 2013.
    1. Finch RG, Metlay JP, Davey PG, Baker LJ, International Forum on Antibiotic Resistance Colloquium (2004); Educational interventions to improve antibiotic use in the community: report from the International Forum on Antibiotic Resistance (IFAR) colloquium (2002). Lancet Infect Dis 4: 44-53.
    1. Goossens H, Guillemot D, Ferech M, Schlemmer B, Costers M et al. (2006) National campaigns to improve antibiotic use. Eur J Clin Pharmacol 62: 373-379. doi:. PubMed: .
    1. Mangione-Smith R, McGlynn EA, Elliott MN, McDonald L, Franz CE et al. (2001) Parent expectations for antibiotics, physician-parent communication, and satisfaction. Arch Pediatr Adolesc Med 155: 800-806. doi:. PubMed: .
    1. Wroth TH, Pathman DE (2006) Primary medication adherence in a rural population: the role of the patient-physician relationship and satisfaction with care. J Am Board Fam Med 19: 478-486. doi:. PubMed: .
    1. Matsui D, Joubert GI, Dykxhoorn S, Rieder MJ (2000) Compliance with prescription filling in the pediatric emergency department. Arch Pediatr Adolesc Med 154: 195-198. doi:. PubMed: .
    1. Ammentorp J, Mainz J, Sabroe S (2005) Parents’ priorities and satisfaction with acute pediatric care. Arch Pediatr Adolesc Med 159: 127-131. doi:. PubMed: .
    1. Salazar ML, English TM, Eiland LS (2012) Caregivers’ baseline understanding and expectations of antibiotic use for their children. Clin Pediatr (Phila) 51: 632-637. doi:. PubMed: .
    1. Boudreaux ED, O’Hea EL (2004) Patient satisfaction in the Emergency Department: a review of the literature and implications for practice. J Emerg Med 26: 13-26. doi:. PubMed: .
    1. Laos CM, DiStefano MC, Cruz AT, Caviness AC, Hsu DC et al. (2012) Mobile pediatric emergency response team: patient satisfaction during the novel H1N1 influenza outbreak. Acad Emerg Med 19: 274-279. doi:. PubMed: .
    1. Spahr CD, Flugstad NA, Brousseau DC (2006) The impact of a brief expectation survey on parental satisfaction in the pediatric emergency department. Acad Emerg Med 13: 1280-1287. doi:. PubMed: .
    1. Bordley WC (2002) Outcomes research and emergency medical services for children: domains, challenges, and opportunities. Ambul Pediatr 2: 306-310. doi:. PubMed: .
    1. Rega PP, Roberts SM, Khuder S, Boardley D, Brickman K et al. (2012) The delivery of a health promotion intervention by a public health promotion specialist improves patient satisfaction in the emergency department. Acad Emerg Med 19: 313-317. doi:. PubMed: .
    1. World Health Organization (1998) Therapeutic patient education. Available: . Accessed 1 March 2013.
    1. Autorité de Santé Haute (2007) Therapeutic patient education (TPE) Definition, goals, and organisation. Available: . Accessed 8 February 2013.
    1. Barrows HS, Tamblyn RM (1980) Problem-Based Learning: An Approach to Medical Education. New York, NY: Springer Verlag Publishing Company. 206pp.
    1. Wu YP, Roberts MC (2008) A meta-analysis of interventions to increase adherence to medication regimens for pediatric otitis media and streptococcal pharyngitis. J Pediatr Psychol 33: 789-796. doi:. PubMed: .
    1. Pechère JC, Hughes D, Kardas P, Cornaglia G (2007) Non-compliance with antibiotic therapy for acute community infections: a global survey. Int J Antimicrob Agents 29: 245-253. doi:. PubMed: .
    1. Isaacman DJ, Khine H, Losek JD (1997) A simple intervention for improving telephone contact of patients discharged from the emergency department. Pediatr Emerg Care 13: 256-258. doi:. PubMed: .
    1. Sixsmith DM, Weissman L, Constant F (1997) Telephone follow-up for case finding of domestic violence in an emergency department. Acad Emerg Med 4: 301-304. doi:. PubMed: .
    1. Altman DG (2009) Missing outcomes in randomized trials: addressing the dilemma. Open Med 3: e51-e53. PubMed: .
    1. Thomas EJ, Burstin HR, O’Neil AC, Orav EJ, Brennan TA (1996) Patient noncompliance with medical advice after the emergency department visit. Ann Emerg Med 27: 49-55. doi:. PubMed: .
    1. Hall JA, Roter DL, Katz NR (1988) Meta-analysis of correlates of provider behavior in medical encounters. Med Care 26: 657-675. doi:. PubMed: .
    1. Rosman SL, Dorfman D, Suglia SF, Humphrey C, Silverstein M (2012) Predictors of prescription filling after visits to the pediatric emergency department. Pediatr Emerg Care 28: 22-25. doi:. PubMed: .
    1. McNulty CA, Boyle P, Nichols T, Clappison P, Davey P (2007) Don’t wear me out--the public’s knowledge of and attitudes to antibiotic use. J Antimicrob Chemother 59: 727-738. doi:. PubMed: .
    1. Sabuncu E, David J, Bernède-Bauduin C, Pépin S, Leroy M et al. (2009) Significant reduction of antibiotic use in the community after a nationwide campaign in France, 2002-2007. PLOS Med 6: e1000084 PubMed: .
    1. Angoulvant F, Skurnik D, Bellanger H, Abdoul H, Bellettre X et al. (2012) Impact of implementing French antibiotic guidelines for acute respiratory-tract infections in a paediatric emergency department, 2005-2009. Eur J Clin Microbiol Infect Dis 31: 1295-1303. doi:. PubMed: .
    1. Azria R, Barry B, Bingen E, Cavallo JD, Chidiac C et al. (2012) Antibiotic stewardship. Med Mal Infect 42: 460-487. doi:.
    1. Chao JH, Kunkov S, Reyes LB, Lichten S, Crain EF (2008) Comparison of two approaches to observation therapy for acute otitis media in the emergency department. Pediatrics 121: e1352-1356 PubMed: .
    1. Schnellinger M, Finkelstein M, Thygeson MV, Vander Velden H, Karpas A et al. (2010) Animated video vs pamphlet: comparing the success of educating parents about proper antibiotic use. Pediatrics 125: 990-996. doi:. PubMed: .
    1. Andrews T, Thompson M, Buckley DI, Heneghan C, Deyo R et al. (2012) Interventions to influence consulting and antibiotic use for acute respiratory tract infections in children: a systematic review and meta-analysis. PLOS ONE 7: e30334. doi:. PubMed: .
    1. Alder S, Trunnell E, White G, Lyon J, Reading J et al. (2005) Reducing Parental Demand for Antibiotics by Promoting Communication Skills. Am J Health Educ 36: 132-139. doi:.
    1. May L, Cosgrove S, L’Archeveque M, Talan DA, Payne P et al. (2013) A Call to Action for Antimicrobial Stewardship in the Emergency Department: Approaches and Strategies. Ann Emerg Med 62: 69-77. doi:. PubMed: .
    1. Cesarz JL, Steffenhagen AL, Svenson J, Hamedani AG (2013) Emergency department discharge prescription interventions by emergency medicine pharmacists. Ann Emerg Med 61: 209-214. doi:. PubMed: .

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe