title: Effects of clinical pathways for common outpatient infections on antibiotic prescribing.
abstract: BACKGROUND
  Antibiotic overuse in the primary care setting is common. Our objective was to evaluate the effect of a clinical pathway-based intervention on antibiotic use.
  
  
  METHODS
  Eight primary care clinics were randomized to receive clinical pathways for upper respiratory infection, acute bronchitis, acute rhinosinusitis, pharyngitis, acute otitis media, urinary tract infection, skin infections, and pneumonia and patient education materials (study group) versus no intervention (control group). Generalized linear mixed effects models were used to assess trends in antibiotic prescriptions for non-pneumonia acute respiratory infections and broad-spectrum antibiotic use for all 8 conditions during a 2-year baseline and 1-year intervention period.
  
  
  RESULTS
  In the study group, antibiotic prescriptions for non-pneumonia acute respiratory infections decreased from 42.7% of cases at baseline to 37.9% during the intervention period (11.2% relative reduction) (P<.0001) and from 39.8% to 38.7%, respectively, in the control group (2.8% relative reduction) (P=.25). Overall use of broad-spectrum antibiotics in the study group decreased from 26.4% to 22.6% of cases, respectively (14.4% relative reduction) (P<.0001) and from 20.0% to 19.4%, respectively, in the control group (3.0% relative reduction) (P=.35). There were significant differences in the trends of prescriptions for acute respiratory infections (P<.0001) and broad-spectrum antibiotic use (P=.001) between the study and control groups during the intervention period, with greater declines in the study group.
  
  
  CONCLUSIONS
  This intervention was associated with declining antibiotic prescriptions for non-pneumonia acute respiratory infections and use of broad-spectrum antibiotics over the first year. Evaluation of the impact over a longer study period is warranted.
authors.affiliation: Department of Medicine, Denver Health Medical Center, Denver, CO 80204, USA. timothy.jenkins@dhha.org
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Jenkins
authors.forename: Amy
authors.initials: A
authors.lastname: Irwin
authors.forename: Letoynia
authors.initials: L
authors.lastname: Coombs
authors.forename: Lauren
authors.initials: L
authors.lastname: Dealleaume
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Ross
authors.forename: Jeanne
authors.initials: J
authors.lastname: Rozwadowski
authors.forename: Brian
authors.initials: B
authors.lastname: Webster
authors.forename: L Miriam
authors.initials: LM
authors.lastname: Dickinson
authors.forename: Allison L
authors.initials: AL
authors.lastname: Sabel
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Mackenzie
authors.forename: David R
authors.initials: DR
authors.lastname: West
authors.forename: Connie S
authors.initials: CS
authors.lastname: Price
mesh_terms: D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019091:Critical Pathways; D003661:Decision Support Techniques; D004363:Drug Utilization / Q000639:trends*; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012141:Respiratory Tract Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents