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The American Journal of Managed Care October 2017
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Low-Value Antibiotic Prescribing and Clinical Factors Influencing Patient Satisfaction
Adam L. Sharp, MD, MS; Ernest Shen, PhD; Michael H. Kanter, MD; Laura J. Berman, MPH; and Michael K. Gould, MD, MS
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Low-Value Antibiotic Prescribing and Clinical Factors Influencing Patient Satisfaction

Adam L. Sharp, MD, MS; Ernest Shen, PhD; Michael H. Kanter, MD; Laura J. Berman, MPH; and Michael K. Gould, MD, MS
Antibiotics are not required to achieve high patient satisfaction. Patient age, chronic conditions, and an established patient—provider relationship influence satisfaction with acute care.

CONCLUSIONS

Our findings indicate that patient satisfaction scores are slightly lower when antibiotics are not prescribed for some encounters. However, the minimal overall impact may help to assure providers that prescribing unwarranted antibiotics is not required to receive high satisfaction scores, as most (75.4%) AS encounters not receiving antibiotics still resulted in favorable satisfaction scores (vs 79.5%). Additionally, an established patient–provider relationship and encounters with older patients with more comorbidities are more likely to be correlated with high satisfaction scores for acute encounters. These characteristics should be included in future satisfaction research and hospital/provider comparisons. The correlation between low-value care and higher satisfaction should encourage policies to evaluate and incentivize providers not only for high patient satisfaction, but for other important metrics of quality as well. 

Acknowledgments
The authors would like to acknowledge the internal funding from the Kaiser Permanente Southern California Care Improvement Research Team as well as the assistance of Ellen J. Rippberger, MPH, and Lorena Perez-Reynoso for their assistance with this work.

Author Affiliations: Department of Research and Evaluation (ALS, ES, MKG), and Medical Director of Quality and Clinical Analysis (MHK), and Department of Regulatory Relations and Performance Assessment (LJB), Kaiser Permanente Southern California, Pasadena, CA; Department of Emergency Medicine, Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles, CA.

Source of Funding: Internal funding from the KPSC Care Improvement Research Team (CIRT) supported this project. 

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article. 

Authorship Information: Concept and design (ALS, ES, MHK); acquisition of data (LJB); analysis and interpretation of data (ALS, ES, MHK, MKG); drafting of the manuscript (ALS, ES, MHK); critical revision of the manuscript for important intellectual content (ALS, ES, MHK, LJB, MKG); statistical analysis (ES); administrative, technical, or logistic support (LJB); and supervision (ALS, MKG). 

Address Correspondence to: Adam L. Sharp, MD, MS, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101. E-mail: Adam.L.Sharp@kp.org. 
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