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Do clinical and communication skills scores on credentialing exams predict potentially inappropriate antibiotic prescribing?
BACKGROUND: There is considerable variation among physicians in inappropriate antibiotic prescribing, which is hypothesized to be attributable to diagnostic uncertainty and ineffective communication. The objective of this study was to evaluate whether clinical and communication skills are associated...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10621187/ https://www.ncbi.nlm.nih.gov/pubmed/37915014 http://dx.doi.org/10.1186/s12909-023-04817-w |
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author | Tamblyn, Robyn Moraga, Teresa Girard, Nadyne Boulet, John Chan, Fiona K. I. Habib, Bettina |
author_facet | Tamblyn, Robyn Moraga, Teresa Girard, Nadyne Boulet, John Chan, Fiona K. I. Habib, Bettina |
author_sort | Tamblyn, Robyn |
collection | PubMed |
description | BACKGROUND: There is considerable variation among physicians in inappropriate antibiotic prescribing, which is hypothesized to be attributable to diagnostic uncertainty and ineffective communication. The objective of this study was to evaluate whether clinical and communication skills are associated with antibiotic prescribing for upper respiratory infections and sinusitis. METHODS: A cohort study of 2,526 international medical graduates and 48,394 U.S. Medicare patients diagnosed by study physicians with an upper respiratory infection or sinusitis between July 2014 and November 2015 was conducted. Clinical and communication skills were measured by scores achieved on the Clinical Skills Assessment examination administered by the Educational Commission for Foreign Medical Graduates (ECFMG) as a requirement for entry into U.S residency programs. Medicare Part D data were used to determine whether patients were dispensed an antibiotic following an outpatient evaluation and management visit with the study physician. Physician age, sex, specialty and practice region were retrieved from the ECFMG databased and American Medical Association (AMA) Masterfile. Multivariate GEE logistic regression was used to evaluate the association between clinical and communication skills and antibiotic prescribing, adjusting for other physician and patient characteristics. RESULTS: Physicians prescribed an antibiotic in 71.1% of encounters in which a patient was diagnosed with sinusitis, and 50.5% of encounters for upper respiratory infections. Better interpersonal skills scores were associated with a significant reduction in the odds of antibiotic prescribing (OR per score decile 0.93, 95% CI 0.87–0.99), while greater proficiency in clinical skills and English proficiency were not. Female physicians, those practicing internal medicine compared to family medicine, those with citizenship from the US compared to all other countries, and those practicing in southern of the US were also more likely to prescribe potentially unnecessary antibiotics. CONCLUSIONS: Based on this study, physicians with better interpersonal skills are less likely to prescribe antibiotics for acute sinusitis and upper respiratory infections. Future research should examine whether tailored interpersonal skills training to help physicians manage patient expectations for antibiotics could reduce unnecessary antibiotic prescribing. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12909-023-04817-w. |
format | Online Article Text |
id | pubmed-10621187 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-106211872023-11-03 Do clinical and communication skills scores on credentialing exams predict potentially inappropriate antibiotic prescribing? Tamblyn, Robyn Moraga, Teresa Girard, Nadyne Boulet, John Chan, Fiona K. I. Habib, Bettina BMC Med Educ Research BACKGROUND: There is considerable variation among physicians in inappropriate antibiotic prescribing, which is hypothesized to be attributable to diagnostic uncertainty and ineffective communication. The objective of this study was to evaluate whether clinical and communication skills are associated with antibiotic prescribing for upper respiratory infections and sinusitis. METHODS: A cohort study of 2,526 international medical graduates and 48,394 U.S. Medicare patients diagnosed by study physicians with an upper respiratory infection or sinusitis between July 2014 and November 2015 was conducted. Clinical and communication skills were measured by scores achieved on the Clinical Skills Assessment examination administered by the Educational Commission for Foreign Medical Graduates (ECFMG) as a requirement for entry into U.S residency programs. Medicare Part D data were used to determine whether patients were dispensed an antibiotic following an outpatient evaluation and management visit with the study physician. Physician age, sex, specialty and practice region were retrieved from the ECFMG databased and American Medical Association (AMA) Masterfile. Multivariate GEE logistic regression was used to evaluate the association between clinical and communication skills and antibiotic prescribing, adjusting for other physician and patient characteristics. RESULTS: Physicians prescribed an antibiotic in 71.1% of encounters in which a patient was diagnosed with sinusitis, and 50.5% of encounters for upper respiratory infections. Better interpersonal skills scores were associated with a significant reduction in the odds of antibiotic prescribing (OR per score decile 0.93, 95% CI 0.87–0.99), while greater proficiency in clinical skills and English proficiency were not. Female physicians, those practicing internal medicine compared to family medicine, those with citizenship from the US compared to all other countries, and those practicing in southern of the US were also more likely to prescribe potentially unnecessary antibiotics. CONCLUSIONS: Based on this study, physicians with better interpersonal skills are less likely to prescribe antibiotics for acute sinusitis and upper respiratory infections. Future research should examine whether tailored interpersonal skills training to help physicians manage patient expectations for antibiotics could reduce unnecessary antibiotic prescribing. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12909-023-04817-w. BioMed Central 2023-11-01 /pmc/articles/PMC10621187/ /pubmed/37915014 http://dx.doi.org/10.1186/s12909-023-04817-w Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Tamblyn, Robyn Moraga, Teresa Girard, Nadyne Boulet, John Chan, Fiona K. I. Habib, Bettina Do clinical and communication skills scores on credentialing exams predict potentially inappropriate antibiotic prescribing? |
title | Do clinical and communication skills scores on credentialing exams predict potentially inappropriate antibiotic prescribing? |
title_full | Do clinical and communication skills scores on credentialing exams predict potentially inappropriate antibiotic prescribing? |
title_fullStr | Do clinical and communication skills scores on credentialing exams predict potentially inappropriate antibiotic prescribing? |
title_full_unstemmed | Do clinical and communication skills scores on credentialing exams predict potentially inappropriate antibiotic prescribing? |
title_short | Do clinical and communication skills scores on credentialing exams predict potentially inappropriate antibiotic prescribing? |
title_sort | do clinical and communication skills scores on credentialing exams predict potentially inappropriate antibiotic prescribing? |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10621187/ https://www.ncbi.nlm.nih.gov/pubmed/37915014 http://dx.doi.org/10.1186/s12909-023-04817-w |
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