COMPARING PHYSICIANS' AND PATIENTS' EXPECTATIONS FOR ANTIBIOTICS: A STUDY ACROSS MULTIPLE SAMPLES

Purpose: Physician overprescribing of antibiotics has been associated with microbial resistance. Here, we compare the drivers of physician prescribing with patient expectations. We build on prior work, based on fuzzy-trace theory, which has shown that patients make decisions based on categorical gist mental representations that emphasize simple bottom-line meanings such as “Why Not Take a Risk?” – a categorical bottom line of how the option to take antibiotics stacks up against the option not to do. Specifically, we hypothesized that physicians and patients may hold similar bottom-line gists.

Method: We surveyed 149 healthcare providers (47% female; 74% White) recruited from two large urban academic hospital emergency departments in the Mid-Atlantic region between May 19^th and December 26^th, 2015, and 224 patients (61% female; 56% African-American) from one of the emergency departments between April and July 2015. All subjects answered 46 Likert scale questions measuring providers’, or patients’, mental representations, 2 yes/no questions measuring patients’ expectations for antibiotics, and 2 free response questions measuring patients’ knowledge regarding antibiotic prescribing. Analysis was conducted using exploratory factor analysis (EFA).

Results: The “Why Not Take a Risk” gist captured significant unique variance across both provider (13% of variance) and patient (16% of variance) samples. Separate factors captured other relevant gists such as the possibility of harm from side effects (10% of variance for providers; 9% of variance for patients) and that antibiotics might not be safe (6% of variance for providers; 11% of variance for patients). Patients (6% of variance), but not providers, endorsed a gist indicating that antibiotics work against viruses.

Conclusion: Both patients and providers utilize “Why Not Take a Risk?” –  a widespread strategy that is associated with categorical risk perceptions rather than verbatim analysis. Although individually rational, reliance on this gist can lead to socially suboptimal results including antibiotic resistance. These perceptions are associated with physicians’ expectations for antibiotics which can affect their prescribing. Additionally, patients’ expectations have been shown to drive physician behavior. Thus, “Why Not Take a Risk?” may be a strong driver of overprescribing behavior, suggesting opportunities for public health communication interventions and physician education.