Relation of time spent in an encounter with the use of antibiotics in pediatric office visits for viral respiratory infections

Abstract

Objective: To examine the relationship between the time a physician spends in an office encounter with the prescribing of antibiotics for pediatric patients with presumed viral respiratory infections.

Design and setting: Cross-sectional analysis of the 2000 National Ambulatory Medical Care Survey in physician offices in the United States.

Participants: Children and adolescents (aged < or = 18 years) with a diagnosis of upper respiratory infections or bronchitis.

Main outcome measure: The time spent by a physician with a patient in an office encounter.

Results: Analysis of 269 office encounters representing 12,366,162 annual office visits for upper respiratory infections and bronchitis. The mean (SE) number of minutes a doctor spent with a patient in encounters for colds or bronchitis that resulted in an antibiotic prescription was 14.24 (0.85) minutes while 14.18 (1.03) minutes were spent in encounters without antibiotics prescribed. In multivariate analysis, the likelihood that the time spent by a physician was above or below the median visit time of 15 minutes was not associated with the use of antibiotics when controlled for patient age, race, sex, participation in a prepaid plan, or whether the encounter was with the patient's primary care physician.

Conclusions: Prescribing antibiotics for children with upper respiratory infections or bronchitis is not associated with a reduction in the time that a physician spends with a patient in an office encounter. The impact on physician productivity of injudicious antibiotic prescribing for upper respiratory infections and bronchitis may not be as great as previously believed.