title: A randomized controlled trial to change antibiotic prescribing patterns in a community.
abstract: BACKGROUND
  Excessive and inappropriate use of antibiotics has been identified as a leading cause of the emergence of multiply resistant strains of pneumococci.
  
  
  OBJECTIVE
  To examine the effects of academic detailing and a parental education program on community pediatricians' prescription of antibiotics for young children.
  
  
  METHODS
  Physician leaders in study practices prepared educational modules and presented the modules to their practices. The control groups received only practice-specific report cards. Using a time-series analysis, we collected data on office visits and antibiotic prescriptions filled between May 1, 2000, and April 30, 2001 (baseline period), and between May 1, 2001, and April 30, 2002 (intervention period). Antibiotic prescription rate was defined as the ratio of antibiotic prescriptions filled to the number of office visits.
  
  
  RESULTS
  The antibiotic prescription rate decreased to 0.82 (95% confidence interval, 0.71-0.95) of the baseline rate for the study group (6 practices) and to 0.86 (95% confidence interval, 0.77-0.95) of the baseline for the control group (5 practices). Similar patterns for antibiotic prescription rates were seen for study and control groups both before and after the intervention. Wide variations in prescription rates were observed among the practices, but, in general, the control practices had lower antibiotic prescribing rates during both the baseline and the intervention periods. Use of amoxicillin increased slightly in the study group and decreased slightly in the control group. The use of cephalosporins increased slightly in both groups.
  
  
  CONCLUSIONS
  Overall, academic detailing appeared to be no more effective in reducing antibiotic use than the practice-specific report cards alone.
authors.affiliation: Center for Health Care Policy and Clinical Effectiveness, Cincinnati Children's Hospital Medical Center, OH 45229, USA. emanuel.doyne@cchmc.org
authors.forename: Emanuel O
authors.initials: EO
authors.lastname: Doyne
authors.forename: Mary Pat
authors.initials: MP
authors.lastname: Alfaro
authors.forename: Robert M
authors.initials: RM
authors.lastname: Siegel
authors.forename: Harry D
authors.initials: HD
authors.lastname: Atherton
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Schoettker
authors.forename: Jeralyn
authors.initials: J
authors.lastname: Bernier
authors.forename: Uma R
authors.initials: UR
authors.lastname: Kotagal
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services / Q000706:statistics & numerical data / Q000639:trends*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D008297:Male; D009819:Office Visits / Q000706:statistics & numerical data; D009820:Ohio; D010372:Pediatrics / Q000706:statistics & numerical data / Q000639:trends*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends*; D015397:Program Evaluation; D012621:Seasons
chemical_list: D000900:Anti-Bacterial Agents