Antibiotic treatment of acute respiratory tract infections in the elderly: effect of a multidimensional educational intervention.
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.
Gonzales
Ralph
R
Division of General Internal Medicine, Department of Medicine, University of California at San Francisco, San Francisco, California 94118, USA.
Sauaia
Angela
A
Corbett
Kitty K
KK
Maselli
Judith H
JH
Erbacher
Kathleen
K
Leeman-Castillo
Bonnie A
BA
Darr
Carol A
CA
Houck
Peter M
PM
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
D000900:Anti-Bacterial Agents