Knowledge and beliefs, behaviors, and adherence among Latino parents or legal guardians related to antibiotic use for upper respiratory tract infections in children under 6 years of age.

OBJECTIVE: Evaluate parents or legal guardians' knowledge and beliefs, behaviors, and adherence regarding antibiotic use for upper respiratory tract infection (URTI) in their children who are younger than 6 years. DESIGN: A cross-sectional study from September 2016 to February 2017. SETTING: Emergency department with a pediatric unit. PARTICIPANTS: One hundred and one parents or legal guardians who visited one of the selected emergency departments during the study period. INTERVENTION: Administration of a validated questionnaire to assess knowledge and beliefs, behaviors, and adherence regarding antibiotic use for URTI. MAIN OUTCOME MEASURES: Knowledge and beliefs, behaviors, and adherence regarding antibiotic use for URTI. RESULTS: Items with the least desired scores were seen in the "knowledge and beliefs" domain. Higher number of antibiotics used for URTI during the last year (P < 0.01) and lower education level (P = 0.03) were associated with least desired knowledge and beliefs scores. The "behaviors" domain contained the items with the best scores: higher education level (P = 0.05), fewer antibiotics used for URTI during the last year (P = 0.05), and older age (P = 0.02) were the only variables associated with better behaviors. For the "adherence" domain, lower education level (P < 0.01) was associated with poor indicators of adherence. The Cronbach alpha for the "knowledge and beliefs" items was 0.875, the "behaviors" items 0.569, and the "adherence" items 0.798. CONCLUSION: Findings of our study support the need for proper antibiotic education among parents, especially in those with an increased risk of antibiotic misuse and overuse. Pharmacists and physicians need to establish a dialogue with parents or legal guardians to discuss how antibiotics work, what types of infection they treat, and how to prevent antibiotic resistance. Sociodemographic variables can be used to identify at-risk groups and to develop successful interventions.

Prevalence of Concurrent Prescribing of ACE-Is and ARBs among Beneficiaries of Puerto Rico's Government-Sponsored Health Care Plan During 2012 and 2013.

OBJECTIVE: Cardiovascular conditions are the second cause of death in Puerto Rico. The individual use of angiotensin-converting enzyme inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) is considered the first-line therapy for the treatment of several cardiovascular-related medical conditions. However, the concurrent use of these 2 therapeutic classes of drugs is not supported by treatment guidelines. Studies have shown that their concurrent use represents a potential health risk. The research described in this paper aimed to determine the prevalence of the concurrent prescription of ACE-Is and ARBs, either separately or as a combination product, in a group of beneficiaries of the Puerto Rico Health Services Administration (ASES, by its initials in Spanish). METHODS: A 2-year cross sectional study was conducted. All pharmacy claims from the years 2012 and 2013 were provided by ASES and subsequently evaluated by the investigators to identify those involving the prescription of an ACE-I, an ARB, or a combination of drugs belonging to both therapeutic classes. Each pharmacy claim was complemented with sociodemographic and clinical data. The final dataset was analyzed at the person-month level using frequency, cumulative frequency, percentage, and cumulative percentage. RESULTS: The final sample consisted of 361,841 beneficiaries. A total of 23,598 beneficiaries were excluded because of incomplete diagnostic information. Of the beneficiaries with complete information, 36,202 out of 338,243 (10.7%) had concurrent prescriptions for ACE-Is and ARBs during the study period. We excluded 1,124 beneficiaries who had a primary diagnosis of HF, resulting in a final pool of 35,078 beneficiaries (10.4%) who had prescriptions for combination products. CONCLUSION: An unacceptable pattern of ACE-I and ARB co-prescribing during the years 2012 and 2013 was observed in patients with diagnoses for which the combination is not clinically indicated.