Fidelity evaluation of the dialogue around respiratory illness treatment (DART) program communication training

Rita Mangione-Smith; Jeffrey D Robinson; Chuan Zhou; James W Stout; Alexander G Fiks; Madeleine Shalowitz; Jeffrey S Gerber; Dennis Burges; Benjamin Hedrick; Louise Warren; Robert W Grundmeier; Matthew P Kronman; Laura P Shone; Jennifer Steffes; Margaret Wright; John Heritage

doi:10.1016/j.pec.2022.03.011

Fidelity evaluation of the dialogue around respiratory illness treatment (DART) program communication training

Patient Educ Couns. 2022 Jul;105(7):2611-2616. doi: 10.1016/j.pec.2022.03.011. Epub 2022 Mar 14.

Authors

Rita Mangione-Smith¹, Jeffrey D Robinson², Chuan Zhou³, James W Stout⁴, Alexander G Fiks⁵, Madeleine Shalowitz⁶, Jeffrey S Gerber⁷, Dennis Burges⁸, Benjamin Hedrick⁹, Louise Warren¹⁰, Robert W Grundmeier¹¹, Matthew P Kronman¹², Laura P Shone¹³, Jennifer Steffes¹⁴, Margaret Wright¹⁵, John Heritage¹⁶

Affiliations

¹ Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA. Electronic address: Rita.M.Mangione-Smith@kp.org.
² Department of Communication, Portland State University, Portland, OR, USA. Electronic address: jeffreyr@pdx.edu.
³ Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA. Electronic address: Chuan.Zhou@seattlechildrens.org.
⁴ Department of Pediatrics, University of Washington, Seattle, WA, USA. Electronic address: jstout@u.washington.edu.
⁵ Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Primary Care Research, American Academy of Pediatrics, IL, USA. Electronic address: fiks@email.chop.edu.
⁶ Department of Psychiatry and Behavioral Medicine, Rush University School of Medicine, Chicago, IL, USA. Electronic address: Madeleine_Shalowitz@rush.edu.
⁷ Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA. Electronic address: GERBERJ@email.chop.edu.
⁸ Department of Pediatrics, University of Washington, Seattle, WA, USA. Electronic address: dburges@uw.edu.
⁹ Department of Pediatrics, University of Washington, Seattle, WA, USA. Electronic address: bhedrick@uw.edu.
¹⁰ Department of Pediatrics, University of Washington, Seattle, WA, USA. Electronic address: lcnovak@uw.edu.
¹¹ Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA. Electronic address: grundmeier@email.chop.edu.
¹² Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA. Electronic address: matthew.kronman@seattlechildrens.org.
¹³ Primary Care Research, American Academy of Pediatrics, IL, USA. Electronic address: lshone@aap.org.
¹⁴ Primary Care Research, American Academy of Pediatrics, IL, USA. Electronic address: jsteffes@aap.org.
¹⁵ Primary Care Research, American Academy of Pediatrics, IL, USA. Electronic address: mewright@uic.edu.
¹⁶ Department of Sociology, University of California Los Angeles, Los Angeles, CA, USA. Electronic address: heritage@ucla.edu.

Abstract

Objective: To evaluate receipt fidelity of communication training content included in a multifaceted intervention known to reduce antibiotic over-prescribing for pediatric acute respiratory tract infections (ARTIs), by examining the degree to which clinicians implemented the intended communication behavior changes.

Methods: Parents were surveyed regarding clinician communication behaviors immediately after attending 1026 visits by children 6 months to < 11 years old diagnosed with ARTIs by 53 clinicians in 18 pediatric practices. Communication outcomes analyzed were whether clinicians: (A) provided both a combined (negative + positive) treatment recommendation and a contingency plan (full implementation); (B) provided either a combined treatment recommendation or a contingency plan (partial implementation); or (C) provided neither (no implementation). We used mixed effects multinomial logistic regression to determine whether these 3 communication outcomes changed between baseline and the time periods following each of 3 training modules.

Results: After completing the communication training, the adjusted probability of clinicians fully implementing the intended communication behavior changes increased by an absolute 8.1% compared to baseline (95% Confidence Interval [CI]: 2.4%, 13.8%, p = .005).

Conclusions: Our findings support the receipt fidelity of the intervention's communication training content.

Practical implications: Clinicians can be trained to implement communication behaviors that may aid in reducing antibiotic over-prescribing for ARTIs.

Trial registration: ClinicalTrials.gov NCT02943551.

Keywords: Acute respiratory illness; Antibiotic prescribing; Clinician-parent communication; Pediatrics.

Publication types

Research Support, U.S. Gov't, P.H.S.
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Anti-Bacterial Agents / therapeutic use
Child
Communication
Humans
Inappropriate Prescribing
Infant
Practice Patterns, Physicians'*
Respiratory Tract Infections* / drug therapy

Substances

Anti-Bacterial Agents

Associated data

ClinicalTrials.gov/NCT02943551

Grants and funding

R01 HD084547/HD/NICHD NIH HHS/United States