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Expectations for antibiotics increase their prescribing: causal evidence about localized impact

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Title: Expectations for antibiotics increase their prescribing: causal evidence about localized impact
Authors: Sirota, M
Round, T
Samaranayaka, S
Kostopoulou, O
Item 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)
Issue Date: 1-Apr-2017
Date of Acceptance: 27-Oct-2016
URI: http://hdl.handle.net/10044/1/42353
DOI: https://dx.doi.org/10.1037/hea0000456
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/Funder: Cancer Research UK
Funder's Grant Number: C33754/A12222
Keywords: 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
Open Access location: http://www.apa.org/pubs/journals/releases/hea-hea0000456.pdf
Appears in Collections:Division of Surgery
Faculty of Medicine



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