Antibiotic misconceptions persist in Medicaid-insured parents

1. Parents who were younger than 30 years old, did not attend college, and insured by Medicaid were less likely than older, college-educated, and commercially-insured parents to correctly answer questions about the appropriate use of antibiotics.

2. Medicaid-insured parents were also more likely to request physicians to prescribe antibiotics unnecessarily for their children younger than 6 years old.

Study Rundown: Recent data has shown that while antibiotic use has been decreasing over the last 2 decades, more effort is needed to prevent antibiotic resistance. Parental misconceptions have previously been identified as a barrier to decreasing antibiotic use, although it remains unknown whether or not these attitudes have persisted. Authors of the current study sought to investigate current beliefs about antibiotic use among parents with young children from different backgrounds in order to compare with previously gathered data from the year 2000. Researchers found that knowledge deficits have persisted, with several disparities. In particular, parents with commercial health insurance were much more likely to answer survey questions about antibiotic use correctly when compared to those who were Medicaid-insured. Parents with Medicaid were also much more likely to request unnecessary antibiotics. This study may be limited by its lack of generalizability to the national population and the use of an English survey only, which may have introduced potential race/ethnic biases. However, these findings should encourage providers to educate parents about the proper use of antibiotics, focusing especially on parents who are younger with limited education levels, as well as those who are insured by Medicaid.

Click to read the study, published today in Pediatrics

Relevant Reading: Principles of judicious antibiotic prescribing for bacterial upper respiratory tract infections in pediatrics

Study Author, Dr. Louise Vaz, M.D., M.P.H., talks to 2 Minute Medicine: Assistant Professor Pediatric Infectious Diseases, Medical Director, Outpatient Parenteral Antibiotic Therapy Program, Oregon Health & Science University.

“While Medicaid parents showcase higher rates of antibiotic misconception, data indicates low understanding of appropriate treatments for common illnesses regardless of insurance group.  Analyzed data from 2000-2013 found that relatively little progress has been made in correcting key misconceptions.

Over half of Medicaid parents surveyed in 2013 thought antibiotics were necessary for cold and flu treatment, versus 20% of the commercially insured group. Further, 50% of commercially insured parents and over 60% of Medicaid families believed cases of green nasal discharge would require antibiotics. 85% from both groups felt antibiotics would effectively treat bronchitis.

These findings are important to current and future doctors as parental knowledge and attitudes may influence physicians to unnecessarily prescribe antibiotics and contribute to overuse.  Our research indicates that parents still hold strong medical trust in primary care providers.  It is necessary that providers understand that misconceptions still exist, and spend time explaining the rationale behind prescribing, or not prescribing, antibiotics to educate and improve satisfaction of families eager to make their child well.”

In-Depth [cross-sectional study]: In 2013, 354 commercially-insured and 353 Medicaid-insured parents with children <6 years old who were living in Boston, Cambridge, and other surrounding Massachusetts communities completed the study survey. The survey assessed parental knowledge of common childhood infections, antibiotic indications, attitudes toward antibiotics, health care use, and demographics. Parents were asked whether or not antibiotics were indicated for colds or the flu, for deep cough or bronchitis, and for runny nose or green nasal discharge. Results were compared with data obtained from a similar survey which studied the same communities in the year 2000. Medicaid-insured parents were less likely to answer the colds/flu questions (78% vs. 44%, p <.01) and green nasal discharge questions (53% vs. 38%, p <.01) correctly when compared to commercially-insured parents. Parents >30 years old and those with at least a college education were more likely to answer these correctly. Overall, the knowledge about green nasal discharge not requiring antibiotics improved in both groups (commercial: 23% to 49%, p <.01; Medicaid: 22% to 32%, p =.02) from the year 2000. Medicaid-insured parents were 1.4 times more likely in 2013 to request unnecessary antibiotics than in 2000 (p <.01).

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