Misconceptions About Colds and Predictors of Health Service Utilization
Objective. Colds accounted for 1.6 million emergency department (ED) visits and 25 million ambulatory visits by children and adults in 1998. Although most colds are caused by viruses and do not require medical intervention, many families seek health care for the treatment of colds. Parental misconceptions about the cause and appropriate treatment of colds may contribute to unnecessary health service utilization. The objective of this study was to determine predictors of reported ED use and ambulatory care use for colds among families with young children.
Methods. This study was an observational, prospective cohort study to determine attack rates for respiratory illnesses within families that have at least 1 child who is 6 months to 5 years of age and enrolled in out-of-home child care. Families were randomly selected from 5 pediatric practices in Massachusetts and were considered eligible when the child was enrolled in child care with at least 5 other children for 
10 hours per week. Enrolled families were asked to complete a survey that assessed knowledge about colds, antibiotic indications, and frequency of health service utilization. Predictors of self-reported use of health care services were assessed in multivariate logistic regression models.
Results. Of the 261 families enrolled in the study, 197 families (75%) returned completed surveys. Although 93% of parents understood that viruses caused colds, 66% of parents also believed that colds were caused by bacteria. Fifty-three percent believed that antibiotics were needed to treat colds. Parents reported that they would visit the ED (23%) or their doctor’s office (60%) when their child had a cold. Predictors of ED use on multivariate analysis included Medicaid insurance (odds ratio [OR]: 17.6 [2.2–139.3]), history of wheezing (OR: 18.3 [4.4–75.8]), and belief that antibiotics treat colds (OR: 4.2 [1.4–12.9]). Predictors of ambulatory care use included parent younger than 30 years (OR: 10.0 [1.6–64.3]), history of wheezing (OR: 5.6 [1.1–29.7]), and belief that antibiotics treat colds (OR: 3.8 [1.7–8.5]).
Conclusions. Misconceptions about the appropriate treatment of colds are predictive of increased health service utilization. Targeted educational interventions for families may reduce inappropriate antibiotic-seeking behavior and unnecessary health service utilization for colds.
* Divisions of Infectious Diseases
General Pediatrics, Children’s Hospital, Boston, Massachusetts
Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care, Boston, Massachusetts
|| Clinical Research Program, Children’s Hospital, Boston, Massachusetts
Key Words: colds • upper respiratory infections • health service utilization • antibiotics • child care
Abbreviations: URI, upper respiratory tract infection • ED, emergency department • OR, odds ratio
Received for publication May 22, 2002; Accepted Aug 21, 2002.
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