title: Antibiotic treatment of acute respiratory tract infections in the elderly: effect of a multidimensional educational intervention.
abstract: OBJECTIVE
  : To measure and improve antibiotic use for acute respiratory tract infections (ARIs) in the elderly.
  
  
  METHODS
  : Prospective, nonrandomized controlled trial.
  
  
  METHODS
  : Ambulatory office practices in Denver metropolitan area (n=4 intervention practices; n=51 control practices).
  
  
  METHODS
  : Consecutive patients enrolled in a Medicare managed care program who were diagnosed with ARIs during baseline (winter 2000/2001) and intervention (winter 2001/2002) periods. A total of 4,270 patient visits were analyzed (including 341 patient visits in intervention practices).
  
  
  METHODS
  : Appropriate antibiotic use and antibiotic resistance educational materials were mailed to intervention practice households. Waiting and examination room posters were provided to intervention office practices.
  
  
  METHODS
  : Antibiotic prescription rates, based on administrative office visit and pharmacy data, for total and condition-specific ARIs.
  
  
  RESULTS
  : There was wide variation in antibiotic prescription rates for ARIs across unique practices, ranging from 21% to 88% (median=54%). Antibiotic prescription rates varied little by patient age, sex, and underlying chronic lung disease. Prescription rates varied by diagnosis: sinusitis (69%), bronchitis (59%), pharyngitis (50%), and nonspecific upper respiratory tract infection (26%). The educational intervention was not associated with greater reduction in antibiotic prescription rates for total or condition-specific ARIs beyond a modest secular trend (P=.79).
  
  
  CONCLUSIONS
  : Wide variation in antibiotic prescription rates suggests that quality improvement efforts are needed to optimize antibiotic use in the elderly. In the setting of an ongoing physician intervention, a patient education intervention had little effect. Factors other than patient expectations and demands may play a stronger role in antibiotic treatment decisions in elderly populations.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of California at San Francisco, San Francisco, California 94118, USA.
authors.forename: Ralph
authors.initials: R
authors.lastname: Gonzales
authors.forename: Angela
authors.initials: A
authors.lastname: Sauaia
authors.forename: Kitty K
authors.initials: KK
authors.lastname: Corbett
authors.forename: Judith H
authors.initials: JH
authors.lastname: Maselli
authors.forename: Kathleen
authors.initials: K
authors.lastname: Erbacher
authors.forename: Bonnie A
authors.initials: BA
authors.lastname: Leeman-Castillo
authors.forename: Carol A
authors.initials: CA
authors.lastname: Darr
authors.forename: Peter M
authors.initials: PM
authors.lastname: Houck
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003120:Colorado; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare; D010353:Patient Education as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents