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Evidence that Educational Efforts Improve Antibiotic Use

For Healthcare Professionals

Provide educational resources to clinicians and patients on antibiotic prescribing, and ensure access to needed expertise on optimizing antibiotic prescribing.

Evidence Supporting Educational Efforts Targeting Parents and Patients to Improve Antibiotic Use
Reference Interventions and Outcomes Methods, Participants, and Settings Results Conclusions
Mangione-Smith R, et al. Communication Practices and Antibiotic Use for Acute Respiratory Tract Infections in Children. Ann Fam Med 2015. 13(3): 221–227.

 

Intervention:

No intervention; observational study.

Outcome:

Communication techniques used by providers that were associated with prescribing antibiotics for acute respiratory tract infections (ARTIs) and with parent visit satisfaction

 

Methods

Cross-sectional study with parent and provider post-visit surveys

Participants

Pediatric providers

Parents of children (6 months to 10 years old) presenting with complaints consistent with ARTIs

Setting

10 pediatric practices in the United States (Washington)

 

28 pediatric providers

1,284 parents

Communication techniques using recommendations for treating symptoms were associated with lower risk of antibiotic prescribing for ARTIs.

Communication techniques that combined explanations of why antibiotics are not needed with recommendations for treating symptoms were associated with lower risk of antibiotic prescribing and higher parental visit satisfaction.

Communication strategies combining explanations of why antibiotics are not needed with recommendations for treating symptoms may help providers decrease inappropriate antibiotic prescribing while helping maintain parental visit satisfaction.
Mangione-Smith R, et al. Parent expectations for antibiotics, physician-parent communication, and satisfaction. Arch Pediatr Adolesc Med 2001;155(7): 800–806.

 

Intervention

No intervention; observational study.

Outcome

Physician perception of parental pressure for antibiotics

Physician-perceived pressure to prescribe antibiotics

Parental visit-specific satisfaction

 

Methods

Qualitative study involving pre- and post-visit survey

Participants

Physicians and eligible parents who attended acute care visits for their child

Setting

2 private practice pediatric clinics in the United States (California)

10 physicians and 295 parents

Half of parents expected antibiotics before the visit, but only 1% of visits verbally requested them.

Physicians perceived parental expectation for antibiotics 34% of the time without a direct request by parents for antibiotics.

Offering a contingency plan of possibly receiving future antibiotics if their child did not improve was associated with higher satisfaction among parents who expected but did not receive antibiotics.

A contingency plan can be considered for parents expecting antibiotics for their children who do not need antibiotics.
Roberts, RM, et al. Can Improving Knowledge of Antibiotic-Associated Adverse Drug Events Reduce Parent and Patient Demand for Antibiotics? Health Serv Res and Man Epi 2015. 1–5.

 

Intervention

No intervention; observational study.

Outcomes:

Patient and parent knowledge and attitudes about antibiotics and adverse drug events (ADEs) from antibiotics

 

Methods

Computer assisted telephone focus groups Participants

Adult patients and mothers of young children

Setting

United States

 

Familiarity with side effects of antibiotics were common.

Few mothers were familiar with severe antibiotic-associated ADEs.

Most mothers felt strongly that information about severe ADEs should be shared with parents at the time an antibiotic is prescribed.

Adult patients did not believe that antibiotic-associated ADEs was a significant issue.

Parents of pediatric patients are interested in information about antibiotic-associated ADEs.

Adult patients may be less receptive about receiving information about antibiotic-associated ADEs.

 

Evidence Supporting Educational Efforts Targeting Clinicians to Improve Antibiotic Use
Reference Interventions and Outcomes Methods, Participants, and Settings Results Conclusions
Butler CC, et al. Effectiveness of multifaceted educational program to reduce antibiotic dispensing in primary care: Practice based randomized controlled trial. BMJ 2012;344:d8173. Intervention

Multifaceted clinician education, including communication skills, targeting antibiotic prescribing versus standard care

Audit and feedback of practice antibiotic dispensing data

Outcomes

Primary: total number of antibiotics dispensed per 1000 patients by practice

Secondary:

Return visits and hospital admissions for respiratory tract infections, and cost

Methods

Randomized controlled trial

Participants

General practitioners

Setting

General practices in the United Kingdom (Wales)

68 practices serving 480,000 patients

A 4.2% reduction in total antibiotic prescribing was observed in the intervention group compared with controls in one year (p = 0.02).

No differences in hospital admissions or return visits for respiratory tract infections were observed between the intervention and control groups.

5.5% non-significant decreased in antibiotic dispensing cost in intervention group compared with controls

A clinician educational intervention led to reductions in antibiotic dispensing with no changes in hospital admissions, return visits, or costs.
Harris RH, et al. Optimizing antibiotic prescribing for acute respiratory tract infections in an urban urgent care clinic. J Gen Internal Med 2003.18(5):326–34.

 

Intervention

Clinician education targeting antibiotic prescribing for acute respiratory tract infections (ARTIs)

Posters directed at providers placed in exam rooms

Patient education through an interactive computerized education (ICE) module.

Patients who chose not to participate in the ICE were considered to have been exposed to the “limited” intervention

Outcomes

Proportion of patients with ARTIs who received antibiotics

 

Methods

Prospective, nonrandomized controlled trial

Participants

Adults with ARTIs

Setting

Urban urgent care clinic serving the major public hospital in the United States (Colorado)

 

554 adults with ARTIs

Antibiotic prescribing for patients diagnosed with acute bronchitis decreased from 58% to 30% in those exposed to the limited intervention, and to 24% among those exposed to full intervention (p<0.001 compared with baseline).

Antibiotic prescribing for nonspecific upper respiratory tract infections decreased from 14% to 3% in those exposed to the limited intervention, and to 1% among those exposed to the full intervention (p<0.001 compared with baseline).

A combination of patient and provider educational materials can reduce antibiotic prescribing for adults with ARTIs.

 

Juzych NS, et al. Improvements in antimicrobial prescribing for treatment of upper respiratory tract infections through provider education. J Gen Internal Med 2005. 20(10):901–5.

 

Intervention

Clinician education using interactive and case-based learning targeting antibiotic prescribing for upper respiratory tract infections (URIs)

Outcomes

Improvements in antibiotic prescribing for URIs

Methods

Prospective nonrandomized controlled trial

Participants

Primary care physicians

Setting

Four primary care clinics within a staff model health maintenance organization in the United States (Michigan)

30 primary care physicians

Antibiotic prescribing in the intervention group decreased 24.6% for both pediatric and adult medicine clinicians.

In the control group, no significant decline in antibiotic prescribing was observed.

 

An educational program involving interaction and case-based learning improved antibiotic prescribing for URIs by primary care providers.
Academic Detailing
Reference Interventions and Outcomes Methods, Participants, and Settings Results Conclusions
Gjelstad, S., et al. Improving antibiotic prescribing in acute respiratory tract infections: cluster randomized trial from Norwegian general practice (prescription peer academic detailing (Rx-PAD) study). BMJ 2013. 347: f4403.

 

Intervention

Academic detailing on antibiotic prescribing for respiratory tract infections

Clinician education

Audit and feedback

Outcomes

Improvements in antibiotic prescribing for respiratory tract infections

Improvements in broad-spectrum antibiotic prescribing

Methods

Cluster randomized controlled trial

Participants

General practitioners

Setting

General practice clinics in Norway

382 general practitioners

Reductions in antibiotic prescribing were observed in the intervention group compared with the control groups (odds ratio 0.72, 95% confidence interval 0.61 to 0.84).

Prescribing of non-penicillin V drugs also decreased in the intervention arm (0.64, 0.49 to 0.82).

 

Education interventions improved antibiotic prescribing among general practitioners in Norway.

 

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