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Poster-Based Interventions

For Healthcare Professionals

Appropriate antibiotic use posters on display within a clinical setting can serve several purposes, including educating patients and clinicians, reducing patient expectations for an antibiotic, and advertising clinician commitment to judicious antibiotic prescribing to patients and office staff. Below is a brief list of research studies which have explored poster-based interventions to reduce inappropriate antibiotic prescribing for outpatients.

Evidence of Poster-Based Interventions to Reduce Outpatient Antibiotic Prescribing

Reference Objective Setting Intervention Impact Conclusions
Meeker D, et al. Nudging guideline-concordant antibiotic prescribing: A randomized clinical trial. JAMA Intern Med. 2014;174(3):425-31. Investigate the use of a poster displaying public commitment to judicious antibiotic use on prescribing practices for acute respiratory infections (ARIs). Randomized clinical trial in 5 outpatient primary care clinics.

954 adults had ARI visits during the study timeframe: 449 patients were treated by clinicians randomized to the posted commitment letter (335 in the baseline period, 114 in the intervention period); 505 patients were treated by clinicians randomized to standard practice control (384 baseline, 121 intervention).

Poster-sized commitment letters were placed on posters in examination rooms for 12 weeks. Letters displayed clinician photographs and signatures, and stated their commitment to avoid inappropriate antibiotic prescribing for ARIs. Main outcome measure was antibiotic prescribing rates for antibiotic-inappropriate ARI diagnoses in baseline and intervention periods, adjusted for patient age, sex, and insurance status. Baseline rates were 43.5% and 42.8% for control and poster, respectively. During the intervention period, inappropriate prescribing rates increased to 52.7% for controls but decreased to 33.7% in the posted commitment letter condition. Controlling for baseline prescribing rates, the posted commitment letter resulted in a 19.7 absolute percentage reduction in inappropriate antibiotic prescribing rate relative to control (P = .02). Displaying poster-sized commitment letters in examination rooms decreased inappropriate antibiotic prescribing for ARIs. The effect of this simple, low-cost intervention is comparable in magnitude to costlier, more intensive quality-improvement efforts.
Ackerman SL, et al. One size does not fit all: Evaluating an intervention to reduce antibiotic prescribing for acute bronchitis. BMC Health Serv Res. 2013;13(1):462. Use mixed methods to understand why a previous multi-level intervention to reduce antibiotic prescribing for acute bronchitis among primary care clinicians resulted in improvement in only one-third of clinicians. Structured telephone surveys at high- and low-performing sites within a health system in Pennsylvania (n = 29), clinician perspectives on print-based and electronic intervention strategies, and antibiotic prescribing were elicited after the first year of outpatient stewardship intervention. Compared with a survey on antibiotic use conducted 10 years earlier, clinicians demonstrated greater awareness of antibiotic resistance and how it is impacted by individual prescribing decisions—including their own. Perceived barriers to reducing prescribing included patient expectations, time pressure, and diagnostic uncertainty. These factors were reported as undermining effectiveness of specific intervention components. An exam room poster depicting a diagnostic algorithm was the most popular strategy. Future efforts to reduce antibiotic prescribing should address multi-level barriers identified by clinicians and tailor strategies to differences at individual clinician and group practice levels, focusing in particular on changing how patients and providers make decisions together about antibiotic use.
Ashe D, et al. Educational posters to reduce antibiotic use. J Pediatr Health Care. 2006;20(3):192-7. Examine the effectiveness of a waiting room poster in reducing excessive antibiotic use in clinical practice. 1-month trial of an educational poster with historical controls using 3 private pediatric group practices in New York. Children between the ages of 6 months and 10 years with symptoms of respiratory illness were enrolled as subjects. Antibiotic prescriptions for children with respiratory illnesses seen during the poster month were compared with prescriptions written during three 1-month historical control periods. Proportion of visits that resulted in a prescription for an antibiotic served as the outcome measure. 326 of the 720 patients (45.2%) enrolled in the study were treated with an antibiotic. Multiple logistic regression analysis revealed no significant difference in the proportion of visits resulting in an antibiotic prescription among the 4 study months (P = .79), indicating that the educational poster had no effect on antibiotic use. Public education in the form of a waiting room poster was not sufficient to decrease antibiotic prescriptions. This finding has implications for current large-scale programs and for clinicians as they continue to attempt to educate patients on the appropriate use of antibiotics.

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