The "minimizing antibiotic resistance in Colorado" project: impact of patient education in improving antibiotic use in private office practices

Abstract

Objective: To assess the marginal impact of patient education on antibiotic prescribing to children with pharyngitis and adults with acute bronchitis in private office practices.

Data sources/study setting: Antibiotic prescription rates based on claims data from four managed care organizations in Colorado during baseline (winter 2000) and study (winter 2001) periods.

Study design: A nonrandomized controlled trial of a household and office-based patient educational intervention was performed. During both periods, Colorado physicians were mailed antibiotic prescribing profiles and practices guidelines as part of an ongoing quality improvement program. Intervention practices (n=7) were compared with local and distant control practices.

Data collection/extraction methods: Office visits were extracted by managed care organizations using International Classification of Diseases-9-Clinical Modification codes for acute respiratory tract infections, and merged with pharmacy claims data based on visit and dispensing dates coinciding within 2 days.

Principal findings: Adjusted antibiotic prescription rates during baseline and study periods increased from 38 to 39 percent for pediatric pharyngitis at the distant control practices, and decreased from 39 to 37 percent at the local control practices, and from 34 to 30 percent at the intervention practices (p=.18 compared with distant control practices). Adjusted antibiotic prescription rates decreased from 50 to 44 percent for adult bronchitis at the distant control practices, from 55 to 45 percent at the local control practices, and from 60 to 36 percent at the intervention practices (p<.002 and p=.006 compared with distant and local control practices, respectively).

Conclusions: In office practices, there appears to be little room for improvement in antibiotic prescription rates for children with pharyngitis. In contrast, patient education helps reduce antibiotic use for adults with acute bronchitis beyond that achieved by physician-directed efforts.

Figure 1A

Adjusted Antibiotic Prescription Rates for Children with Acute Pharyngitis. The changes in antibiotic prescription rates from baseline to study period are compared between sites. There is no significant change (p>.05) between sites after controlling for patient age, gender, physician specialty, and clustering by office practice, physician, and managed care organization.

Figure 1B

Adjusted Antibiotic Prescription Rates for Adults with Acute Bronchitis. The changes in antibiotic prescription rates from baseline to study period are compared between sites. After controlling for patient age, gender, physician specialty, and clustering by office practice, physician, and managed care organization, antibiotic prescription rates decreased a greater amount at the intervention site compared with distant (p<.002) and local (p=.006) control sites.