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Am Fam Physician. 2003;67(11):2384-2390

Millions of parents take their children to emergency departments and ambulatory care sites for uncomplicated upper respiratory tract infections, resulting in unnecessary expenditures and the generation of inappropriate antibiotic prescriptions. Lee and colleagues conducted an observational, prospective study to examine the impact of misconceptions about the causes of colds and their treatment on the use of health services.

The five-month study involved 197 families with at least one child between the ages of six months and five years. Participants were surveyed regarding family characteristics, health perceptions, knowledge about the causes of illness, beliefs regarding illness transmission, household practices such as hand hygiene and surface disinfection, and perceptions about appropriate antibiotic indications. Outcome variables were users and nonusers for emergency department visits, and frequent versus infrequent users for those in the ambulatory care setting.

Ninety-three percent of parents understood that viruses cause colds, but 66 percent also believed that bacteria were causative, and 53 percent reported that antibiotics were necessary to treat colds. Predictors of emergency department use included Medicaid insurance (odds ratio [OR]: 17.6); child younger than six years with a history of wheezing or reactive airway disease (OR: 18.3); and belief that antibiotics are needed to treat colds (OR: 4.2). Factors associated with ambulatory care use included respondent age younger than 30 years (OR: 10.0); children younger than six years with wheezing or reactive airway disease (OR: 5.6); and belief that antibiotics are needed to treat colds (OR: 3.8).

The authors found that misconceptions about antibiotic use are an independent predictor of emergency department and ambulatory care use. They conclude that a two-pronged educational approach targeting families and physicians can promote judicious antibiotic prescribing.

editor's note: This study reinforces the need to communicate with the public about appropriate use of antibiotics. Although the authors conclude that more communication with parents is necessary, in the past decade the Centers for Disease Control and Prevention and numerous other investigators have directed educational efforts at physicians and the general public. Because a major predictor of health service use for colds is Medicaid insurance, perhaps this is the next area to target with studies and educational efforts. Why do Medicaid patients use health services unnecessarily, and what can be done about it?—C.W.

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