- A new study published in JAMA Internal Medicine found that providers are overprescribing antibiotics for minor respiratory tract infections potentially in an effort to increase patient satisfaction scores.
The study, which looked at patients receiving treatment for a non-bacterial respiratory tract infection between 2013 and 2016, found that prescriptions for common cold symptoms were given at an unnecessarily high rate.
Sixty-six percent of the over 8,000 patients receiving care for their symptoms using telehealth technology received an antibiotic prescription for their viral infection. Typically, viral infections do not require antibiotic treatments.
Although the study did not ask providers why they prescribed antibiotics to their telehealth patients, data about patient satisfaction scores suggested providers issued the treatment because they needed higher ratings. Eighty-seven percent of the telehealth encounters received five out of five stars in patient satisfaction ratings.
However, differences emerged when looking at the treatment options offered following a visit. Seventy-six percent of patients receiving no assigned treatment rated their experiences five out of five stars; 86 percent of patients gave five stars when they received a treatment that was not an antibiotic, and 90 percent gave full marks when they received an antibiotic prescription.
Providers are privy to this link between patient satisfaction and antibiotic prescribing, the researchers suggested. Providers may see high patient satisfaction scores – on which many reimbursements depend – as an incentive to cater to patient wants regardless of medical necessity.
Patient satisfaction and opioids prescribing
Similar results where found with opioids prescribing. A study published in 2018 by the Dartmouth Hitchcock Medical Center found that patients were 32 percent more likely to report high patient satisfaction when doctors prescribed opioids to manage pain.
Of the over 19,500 adult patients who experienced a musculoskeletal issue during the study test period, 2,564 used an opioid to manage pain, meaning patients received a prescription at least once within two six-month periods.
Overall, opioid users were 32 percent more likely to report high patient satisfaction, or rank in the top quartile for patient satisfaction.
After adjusting for comorbidities and other factors, the researchers found that moderate and heavy prescription opioid users were 55 and 43 percent more likely to report high patient satisfaction, respectively.
But with the industry’s focus on addressing the opioid epidemic, experts are reconsidering the use of opioids in pain management. Providers largely agree that unnecessary opioid treatment is a dangerous gateway to medication misuse or drug diversion.
But with some payments hinging on higher satisfaction scores, many providers have become conflicted. This study adds to the volume of evidence that providers who prescribe opioids for pain management could see higher satisfaction scores, and therefore improve their reimbursement rates.
“Against the backdrop of excessive health care use, the United States is facing a crisis of prescription opioid drug misuse and diversion resulting in epidemic levels of morbidity and mortality,” the Dartmouth research team said.
“The rise in the prescription of opioids was presumably initially driven by a desire to improve the well-being of patients having pain,” the team continued. “If, in fact, prescription opioid use is associated with higher patient satisfaction with care, such payment incentives may be perpetuating the prescribing of these medications.”
How do we manage prescribing rates, patient satisfaction?
Although prescribing a cold medication and an opioid have drastically different risks, both studies point to an important question about medication over-prescribing and utilization: how should providers reconcile their patients’ satisfaction with care and judicious prescribing habits?
Most providers agree that this is an extremely delicate balance to strike. But in order to address the issue of prescribing and patient satisfaction, providers need to lean on their interpersonal skills and education techniques.
“I try to educate patients on what their condition is and what are the options of treatment,” Arianna Desillier, MD, who practices anesthesiology at Tufts Medical Center, said in an interview with PatientEngagementHIT.com.
“I usually try to give more than one option of treatment if appropriate; most of the time it’s appropriate. I truly believe in communicating with the patient, spending time listening to the patient, and educating the patient on what their condition is and what the options of treatment is.”
Other providers use clear communication skills and provider empathy to discuss the various causes of chronic pain, and how addressing those causes through non-opioid treatments can better support patients.
Similar principles could stand when looking at prescribing habits for viral respiratory tract infections, some experts say. In theory, prescribing rates should match the incidence of bacterial respiratory tract infections.
When a provider encounters a patient with a viral respiratory tract infection, it could be ideal to explain to patients the differences between viral and bacterial, and how different treatments work better for either condition.
But often, it is easier and more timely for a provider to simply prescribe the medication, a separate study looking at the same trend found. The study, which used the same data set as the JAMA study, found that providers know it is best to deliver better patient education about common cold treatments, but that it’s less cumbersome to simply prescribe the antibiotic.
To combat that trend, policymakers could implement incentives for delivering this level of patient education about treatment. Additionally, policymakers may consider different incentives for reimbursements based on patient satisfaction; these policies should be more nuanced, taking into consideration both the importance of patient satisfaction and of better medication prescribing stewardship.