Can an educational intervention aimed at both patients and physicians reduce antibiotic prescribing for adult patients with a cough?
A multifaceted educational intervention aimed at patients and physicians, along with performance feedback for physicians, safely reduced antibiotic prescribing by over one-third among patients with uncomplicated bronchitis in one health plan.
Why is this important?
To help curb the spread of antibiotic-resistant pathogens, the widespread overuse of antibiotics must be reduced. In response to perceived patient expectations, however, physicians continue to prescribe antibiotics for conditions such as the common cold and bronchitis (cough). Since most of these illnesses are caused by a virus, such prescribing is often not indicated or effective (Gonzales et al. 1999).
Interventions
A Colorado health plan implemented a multifaceted intervention to promote appropriate antibiotic use for bronchitis. Components included educational materials displayed in clinics and mailed to patients' homes, along with professional education and performance feedback for affiliated physicians.
Findings
The antibiotic prescribing rate decreased by more than one-third among adult patients with uncomplicated bronchitis who visited a clinic that received the intervention. The antibiotic prescribing rate did not change significantly in two control clinics that did not receive the intervention, or in a limited intervention clinic that only displayed educational materials in the clinic.
Reduced antibiotic use did not lead to more return office visits for bronchitis or pneumonia, nor to increased use of non-antibiotic prescription treatments compared with the control group, or to reduced patient satisfaction (Gonzales et al. 1999).
Implications
A systematic review of studies confirms that multifaceted interventions such as this, which combine physician and patient education in a variety of venues and formats, are the most successful in reducing antibiotic prescribing for inappropriate indications (Arnold and Straus 2005).
Another systematic review found that improvement interventions in the outpatient setting reduced antibiotic prescribing for acute respiratory infections by about 9 percent on average (Ranji et al. 2006). Active educational interventions, such as one-on-one outreach, consensus-building sessions, and workshops, were more effective than passive strategies such as literature distribution and lectures.
Improvement Ideas and Resources
Visit the Web site of the University of Colorado Health Sciences Center, Division of General Internal Medicine, to view examples of educational materials used in the intervention.
Measure:
This was a prospective controlled trial measuring antibiotic prescribing for consecutive patients with uncomplicated acute bronchitis visiting four selected primary care practices of a group-model health maintenance organization (HMO) in Denver, Colorado. The sample included 2,462 adult patients at baseline (November 1996 to February 1997) and 2,027 in the study period (November 1997 to February 1998). The antibiotic prescribing rate was the percentage of office visits by adults diagnosed with uncomplicated bronchitis for which an antibiotic was dispensed by the health plan's pharmacy. The change in the antibiotic prescribing rate for the full intervention site was statistically significant. There was no significant change in prescribing at two control (usual care) sites or at a limited, office-based educational intervention site (Gonzales et al. 1999).
Limitations:
Although sites had similar baseline antibiotic prescribing rates, they were not randomized to intervention and control groups. The magnitude of the results might not be generalizable outside the group model HMO practice setting.
Source:
Data on filled prescriptions were extracted from an administrative pharmacy database. The study was conducted by researchers at the University of Colorado Health Sciences Center and Kaiser Permanente of Colorado (Gonzales et al. 1999).
References:
* Indicates source of data used in the chart(s).Arnold, S. R., and S. E. Straus. 2005. Interventions to Improve Antibiotic Prescribing Practices in Ambulatory Care. Cochrane Database of Systematic Reviews (4): CD003539.
* Gonzales, R., J. F. Steiner, A. Lum et al. 1999. Decreasing Antibiotic Use in Ambulatory Practice: Impact of a Multidimensional Intervention on the Treatment of Uncomplicated Acute Bronchitis in Adults. Journal of the American Medical Association 281 (16): 15129.
Ranji, S. R., M. A. Steinman, K. G. Shojania et al. 2006. Antibiotic Prescribing Behavior. Vol. 4 of Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies; Technical Review 9. Rockville, Md.: Agency for Healthcare Research and Quality.