The "minimizing antibiotic resistance in Colorado" project: impact of patient education in improving antibiotic use in private office practices.
OBJECTIVE
To assess the marginal impact of patient education on antibiotic prescribing to children with pharyngitis and adults with acute bronchitis in private office practices.


METHODS
Antibiotic prescription rates based on claims data from four managed care organizations in Colorado during baseline (winter 2000) and study (winter 2001) periods.


METHODS
A nonrandomized controlled trial of a household and office-based patient educational intervention was performed. During both periods, Colorado physicians were mailed antibiotic prescribing profiles and practices guidelines as part of an ongoing quality improvement program. Intervention practices (n=7) were compared with local and distant control practices.


METHODS
Office visits were extracted by managed care organizations using International Classification of Diseases-9-Clinical Modification codes for acute respiratory tract infections, and merged with pharmacy claims data based on visit and dispensing dates coinciding within 2 days.


RESULTS
Adjusted antibiotic prescription rates during baseline and study periods increased from 38 to 39 percent for pediatric pharyngitis at the distant control practices, and decreased from 39 to 37 percent at the local control practices, and from 34 to 30 percent at the intervention practices (p=.18 compared with distant control practices). Adjusted antibiotic prescription rates decreased from 50 to 44 percent for adult bronchitis at the distant control practices, from 55 to 45 percent at the local control practices, and from 60 to 36 percent at the intervention practices (p<.002 and p=.006 compared with distant and local control practices, respectively).


CONCLUSIONS
In office practices, there appears to be little room for improvement in antibiotic prescription rates for children with pharyngitis. In contrast, patient education helps reduce antibiotic use for adults with acute bronchitis beyond that achieved by physician-directed efforts.
Gonzales
Ralph
R
Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA 94118, USA.
Corbett
Kitty K
KK
Leeman-Castillo
Bonnie A
BA
Glazner
Judith
J
Erbacher
Kathleen
K
Darr
Carol A
CA
Wong
Shale
S
Maselli
Judith H
JH
Sauaia
Angela
A
Kafadar
Karen
K
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001991:Bronchitis / Q000175:diagnosis / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D003120:Colorado; D004351:Drug Resistance; D004363:Drug Utilization / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008329:Managed Care Programs / Q000592:standards; D008875:Middle Aged; D010353:Patient Education as Topic; D010612:Pharyngitis / Q000175:diagnosis / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D011331:Private Practice / Q000592:standards
D000900:Anti-Bacterial Agents