Expectations for antibiotics increase their prescribing: causal evidence about localized impact
File(s)Sirota_et_al_HEA-2016-3780R2_Preprint.pdf (487.51 KB)
Accepted version
Author(s)
Sirota, M
Round, T
Samaranayaka, S
Kostopoulou, O
Type
Journal Article
Abstract
Objective: Clinically irrelevant but psychologically important factors such as patients’ expectations for antibiotics encourage overprescribing. We aimed to (a) provide missing causal evidence of this effect, (b) identify whether the expectations distort the perceived probability of a bacterial infection either in a pre- or postdecisional distortions pathway, and (c) detect possible moderators of this effect. Method: Family physicians expressed their willingness to prescribe antibiotics (Experiment 1, n₁ = 305) or their decision to prescribe (Experiment 2, n₂ = 131) and assessed the probability of a bacterial infection in hypothetical patients with infections either with low or high expectations for antibiotics. Response order of prescribing/probability was manipulated in Experiment 1. Results: Overall, the expectations for antibiotics increased intention to prescribe (Experiment 1, F(1, 301) = 25.32, p< .001, η p² = .08, regardless of the response order; Experiment 2, odds ratio [OR] = 2.31, and OR = 0.75, Vignettes 1 and 2, respectively). Expectations for antibiotics did not change the perceived probability of a bacterial infection (Experiment 1, F(1, 301) = 1.86, p = .173, ηp² = .01, regardless of the response order; Experiment 2, d = −0.03, and d = +0.25, Vignettes 1 and 2, respectively). Physicians’ experience was positively associated with prescribing, but it did not moderate the expectations effect on prescribing. Conclusions: Patients’ and their parents’ expectations increase antibiotics prescribing, but their effect is localized—it does not leak into the perceived probability of a bacterial infection. Interventions reducing the overprescribing of antibiotics should target also psychological factors. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Date Issued
2017-04-01
Date Acceptance
2016-10-27
Citation
Health Psychology, 2017, 36 (4), pp.402-409
ISSN
1930-7810
Publisher
American Psychological Association
Start Page
402
End Page
409
Journal / Book Title
Health Psychology
Volume
36
Issue
4
Copyright Statement
© 2017 American Psychological Association.
Sponsor
Cancer Research UK
Grant Number
C33754/A12222
Subjects
Social Sciences
Psychology, Clinical
Psychology
antibiotics prescribing
subjective probability
clinical decision-making
nonclinical factors
probability distortion
RESPIRATORY-TRACT INFECTIONS
DECISION-MAKING
PRIMARY-CARE
SUBJECTIVE PROBABILITIES
QUESTIONNAIRE
RESISTANCE
DIAGNOSIS
BEHAVIOR
EVENTS
BIAS
Analysis of Variance
Anti-Bacterial Agents
Bacterial Infections
Humans
Medical Overuse
Odds Ratio
Parents
Patients
Physicians, Family
Practice Patterns, Physicians'
Probability
Respiratory Tract Infections
Public Health
11 Medical And Health Sciences
13 Education
17 Psychology And Cognitive Sciences
Publication Status
Published