Optimizing antibiotic prescribing for acute respiratory tract infections in an urban urgent care clinic.
OBJECTIVE
To decrease unnecessary antibiotic use for acute respiratory tract infections in adults in a point-of-service health care setting.


METHODS
Prospective, nonrandomized controlled trial.


METHODS
An urban urgent care clinic associated with the major indigent care hospital in Denver, Colorado between October 2000 and April 2001.


METHODS
Adults diagnosed with acute respiratory tract infections (bronchitis, sinusitis, pharyngitis, and nonspecific upper respiratory infection). A total of 554 adults were included in the baseline period (October to December 2000) and 964 adults were included in the study period (January to April 2001).


METHODS
A provider educational session on recommendations for appropriate antibiotic use recently published by the Centers for Disease Control and Prevention, and placement of examination room posters were performed during the last week of December 2000. Study period patients who completed a brief, interactive computerized education (ICE) module were classified as being exposed to the full intervention, whereas study period patients who did not complete the ICE module were classified as being exposed to the limited intervention.


RESULTS
The proportion of patients diagnosed with acute bronchitis who received antibiotics decreased from 58% during the baseline period to 30% and 24% among patients exposed to the limited and full intervention, respectively (P <.001 for intervention groups vs baseline). Antibiotic prescriptions for nonspecific upper respiratory tract infections decreased from 14% to 3% and 1% in the limited- and full-intervention groups, respectively (P <.001 for intervention groups vs baseline).


CONCLUSIONS
Antibiotic use for adults diagnosed with acute respiratory tract infections can be reduced in a point-of-service health care setting using a combination of patient and provider educational interventions.
Harris
Robert H
RH
Denver Health and Hospital Authority, University of Colorado Health Sciences Center and University of Colorado at Denver, USA. Rharris@dhha.org
MacKenzie
Thomas D
TD
Leeman-Castillo
Bonnie
B
Corbett
Kitty K
KK
Batal
Holly A
HA
Maselli
Judith H
JH
Gonzales
Ralph
R
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003151:Community Health Centers / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization; D004502:Education, Medical, Continuing / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D014505:Urban Population
D000900:Anti-Bacterial Agents