An evaluation of statewide strategies to reduce antibiotic overuse.
BACKGROUND
The rapid increase of antibiotic resistance poses a significant threat to human health. Overuse of antibiotics has been linked to rates of antibiotic resistance. This study assessed the utility of two common interventions--1) practice profiling and feedback and 2) patient education materials--implemented to decrease antibiotic prescribing for pediatric upper respiratory infections (URIs).


METHODS
Based on Medicaid regions in Kentucky, primary care physicians managing pediatric respiratory infections in Medicaid were randomized into four groups. Groups received either 1) performance feedback only, 2) patient education materials only, 3) both feedback and education materials, or 4) no intervention. Participating physicians had their antibiotic prescribing assessed for the period of July 1, 1996, to November 30, 1997, with an intervention in June 1997. The study included 216 physicians and 124,092 episodes of care.


RESULTS
All groups increased in proportion of episodes with antibiotics between the pre-intervention and post-intervention periods. Prescribing in the patient education group and the patient education and feedback group increased at a significantly lower rate than in the control group. Physicians did not change their coding of illness to justify antibiotics after the intervention, and there was no significant generalization of effect of the pediatric intervention on prescribing for adult URIs.


CONCLUSIONS
These interventions demonstrate little if any impact on promoting appropriate antibiotic prescribing. Antibiotic prescribing for viral respiratory infections continues to increase, suggesting concomitant increases in antibiotic resistance.
Mainous
A G
AG
Department of Family Medicine, Medical University of South Carolina, USA. mainouag@musc.edu
Hueston
W J
WJ
Love
M M
MM
Evans
M E
ME
Finger
R
R
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D011307:Drug Prescriptions; D004352:Drug Resistance, Microbial; D004363:Drug Utilization; D017050:Episode of Care; D005069:Evaluation Studies as Topic; D005194:Family Practice; D005246:Feedback; D006801:Humans; D007629:Kentucky; D008484:Medicaid; D010353:Patient Education as Topic; D010818:Practice Patterns, Physicians'; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000821:virology; D014481:United States
D000900:Anti-Bacterial Agents