Characterizing Parental and Provider Beliefs on Antimicrobial Resistance and Prescribing Practices: A Survey-Based Study

Abstract Corresponding Author: Shannon Hamilton, DO. Ryan White Center for Pediatric Infectious Diseases, Indiana University School of Medicine, Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, Indiana, USA, Email: [email protected] Abbreviations: primary care center (PCC), Sources of funds: This work was supported by the Pediatric Infectious Diseases Society Health Disparities Fellowship funded by Sanofi Pasteur. No conflict of interest Background There are few studies investigating the drivers of health disparities in pediatric antimicrobial prescription. The purpose of this study is to assess baseline knowledge, parental expectations and provider bias in relationship to antimicrobial prescription and resistance. Methods This is an anonymous, voluntary exploratory survey of parents of pediatric patients at a primary care center (PCC) and healthcare providers at a pediatric emergency department and PCC in Indianapolis, IN between April and June 2023. Parents were enrolled in the waiting room of the PCC and completed a paper survey. Providers completed a unique, electronically delivered survey. The survey collected demographic/ socioeconomic data and information on knowledge/expectations of antibiotic use and resistance. Results A total of 100 parents and 54 providers participated. Overall, parents disagreed that a doctor’s decision to prescribe antibiotics could be influenced by bias based on race/ethnicity or a family’s level of income (74.4% and 75.9%, respectively). Over 80% had heard the term “antibiotic resistance” and 54.9% agreed that it is a “big problem.” In multivariable analyses controlling for age and place of birth, parents born in the United States were less likely to agree with being worried about the impact of antibiotic resistance on personal/family’s health (OR 0.11, 95% CI 0.03, 0.41, p=0.001). For physician respondents, about 85% agreed that antimicrobial resistance is a significant problem for children in their community while only about 52% agreed that there are disparities in antibiotic prescribing across racial/ethnic groups and income levels. Eighty-seven percent of physicians agreed that parental expectations to receive an antibiotic may influence provider decision-making. Conclusions This exploratory survey revealed that most parents and providers were not concerned about disparate antimicrobial prescription practices, while most parents had heard of the term antimicrobial resistance and most providers agreed it is a significant problem. Larger studies are needed to further investigate the role of provider bias and parental perception in antimicrobial prescription and resistance.