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A multifaceted intervention to improve antimicrobial prescribing for upper respiratory tract infections in a small rural community.
Clin Infect Dis. 2005 Feb 15; 40(4):546-53.CI

Abstract

BACKGROUND

Antibiotic prescribing for upper respiratory tract infections (URTIs) is widespread, is often inappropriate, and may contribute to antibiotic resistance among community-acquired pathogens, such as Streptococcus pneumoniae.

METHODS

A multifaceted intervention involving health care professionals and patients was introduced to a small rural Utah community and included the repetitive use of printed diagnostic and treatment algorithms by professionals. Data on the quantity and class of antibiotic prescribing, which were collected from multiple sources, were measured for the intervention period (from January through June) in 2001 and compared with data for the baseline period during the same months in 2000.

RESULTS

Medicaid claims data revealed that the percentage of patients in the community who received antibiotics for URTIs during the intervention period was 15.6% less than that for the baseline period, whereas the percentage in the rest of rural Utah was relatively stable, with a 1.5% decrease (P=.006). The greatest impact of the intervention was on prescribing for acute bronchitis (decreases of 56.1% and 1.7% in the community and rural Utah, respectively; P=.024) and on prescribing of macrolides (decreases of 13.4% and 0.2% in the community and rural Utah, respectively; P<.001). Community pharmacy data likewise revealed a 17.5% decrease in the rate of antibiotic prescribing during the intervention period (P<.001), with the largest decrease observed for macrolide prescribing (50.9%; P<.001). Chart review data, in contrast, revealed no significant decrease in the percentage of patients with URTI who were prescribed an antibiotic (3.8%; P=.49), although there was a significant decrease of 11.2% in macrolide use (P=.045).

CONCLUSIONS

A multifaceted intervention involving the repetitive use of printed algorithms resulted in modest improvements in antibiotic prescribing for outpatient URTIs, although one data source did not corroborate this. However, macrolide prescribing decreased sharply, irrespective of the source of data.

Authors+Show Affiliations

Department of Internal Medicine, University of Utah, School of Medicine, Salt Lake City, UT 84132, USA. Michael.Rubin@hsc.utah.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15712077

Citation

Rubin, Michael A., et al. "A Multifaceted Intervention to Improve Antimicrobial Prescribing for Upper Respiratory Tract Infections in a Small Rural Community." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 40, no. 4, 2005, pp. 546-53.
Rubin MA, Bateman K, Alder S, et al. A multifaceted intervention to improve antimicrobial prescribing for upper respiratory tract infections in a small rural community. Clin Infect Dis. 2005;40(4):546-53.
Rubin, M. A., Bateman, K., Alder, S., Donnelly, S., Stoddard, G. J., & Samore, M. H. (2005). A multifaceted intervention to improve antimicrobial prescribing for upper respiratory tract infections in a small rural community. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 40(4), 546-53.
Rubin MA, et al. A Multifaceted Intervention to Improve Antimicrobial Prescribing for Upper Respiratory Tract Infections in a Small Rural Community. Clin Infect Dis. 2005 Feb 15;40(4):546-53. PubMed PMID: 15712077.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A multifaceted intervention to improve antimicrobial prescribing for upper respiratory tract infections in a small rural community. AU - Rubin,Michael A, AU - Bateman,Kim, AU - Alder,Stephen, AU - Donnelly,Sharon, AU - Stoddard,Gregory J, AU - Samore,Matthew H, Y1 - 2005/01/25/ PY - 2004/06/14/received PY - 2004/10/12/accepted PY - 2005/2/16/pubmed PY - 2006/3/31/medline PY - 2005/2/16/entrez SP - 546 EP - 53 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 40 IS - 4 N2 - BACKGROUND: Antibiotic prescribing for upper respiratory tract infections (URTIs) is widespread, is often inappropriate, and may contribute to antibiotic resistance among community-acquired pathogens, such as Streptococcus pneumoniae. METHODS: A multifaceted intervention involving health care professionals and patients was introduced to a small rural Utah community and included the repetitive use of printed diagnostic and treatment algorithms by professionals. Data on the quantity and class of antibiotic prescribing, which were collected from multiple sources, were measured for the intervention period (from January through June) in 2001 and compared with data for the baseline period during the same months in 2000. RESULTS: Medicaid claims data revealed that the percentage of patients in the community who received antibiotics for URTIs during the intervention period was 15.6% less than that for the baseline period, whereas the percentage in the rest of rural Utah was relatively stable, with a 1.5% decrease (P=.006). The greatest impact of the intervention was on prescribing for acute bronchitis (decreases of 56.1% and 1.7% in the community and rural Utah, respectively; P=.024) and on prescribing of macrolides (decreases of 13.4% and 0.2% in the community and rural Utah, respectively; P<.001). Community pharmacy data likewise revealed a 17.5% decrease in the rate of antibiotic prescribing during the intervention period (P<.001), with the largest decrease observed for macrolide prescribing (50.9%; P<.001). Chart review data, in contrast, revealed no significant decrease in the percentage of patients with URTI who were prescribed an antibiotic (3.8%; P=.49), although there was a significant decrease of 11.2% in macrolide use (P=.045). CONCLUSIONS: A multifaceted intervention involving the repetitive use of printed algorithms resulted in modest improvements in antibiotic prescribing for outpatient URTIs, although one data source did not corroborate this. However, macrolide prescribing decreased sharply, irrespective of the source of data. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/15712077/A_multifaceted_intervention_to_improve_antimicrobial_prescribing_for_upper_respiratory_tract_infections_in_a_small_rural_community_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/427500 DB - PRIME DP - Unbound Medicine ER -