Fidelity Evaluation of the Dialogue Around Respiratory Illness Treatment (DART) Program Communication Training

OBJECTIVE. To evaluate communication training content fidelity included in a multifaceted intervention known to reduce antibiotic over-prescribing for pediatric acute respiratory illnesses (ARTIs), by examining the degree to which clinicians implemented the intended communication behavior changes. METHODS. Parents were surveyed regarding clinician communication behaviors immediately after attending 1,026 visits by children 6 months to < 11 years old diagnosed with ARTIs by 53 clinicians in 18 pediatric practices. Communication outcomes analyzed were whether clinicians: (A) provided both a combined (positive + negative) treatment recommendation and a contingency plan (full implementation); (B) provided either a combined treatment recommendation or a contingency plan (partial implementation); or (C) provided neither (no implementation). We used mixed effects multinomial logistic regression to determine whether these 3 communication outcomes changed between baseline and the time periods following each of 3 training modules. RESULTS. After completing the communication training, the adjusted probability of clinicians fully implementing the intended communication behavior changes increased by an absolute 8.1% compared to baseline (95% Confidence Interval [CI]: 2.4%, 13.8%, p=0.005). CONCLUSIONS. Our findings support the fidelity of the intervention’s communication training content. PRACTICAL IMPLICATIONS. Clinicians can be trained to implement communication behaviors that may aid in reducing antibiotic over-prescribing for ARTIs.