The "Minimizing antibiotic resistance in colorado" project: Impact of patient education in improving antibiotic use in private office practices

被引:55
作者
Gonzales, R
Corbett, KK
Leeman-Castillo, BA
Glazner, J
Erbacher, K
Darr, CA
Wong, S
Maselli, JH
Sauaia, A
Kafadar, K
机构
[1] Univ Calif San Francisco, Div Gen Internal Med, Dept Med, San Francisco, CA 94118 USA
[2] Univ Colorado, Dept Anthropol, Denver, CO 80202 USA
[3] Univ Colorado, Hlth & Behav Sci Program, Denver, CO 80202 USA
[4] Univ Colorado, Dept Math, Denver, CO 80202 USA
[5] Univ Colorado, Hlth Sci Ctr, Dept Prevent Med & Biometr, Boulder, CO 80309 USA
[6] Univ Colorado, Hlth Sci Ctr, Div Hlth Care Policy & Res, Boulder, CO 80309 USA
[7] Univ Colorado, Hlth Sci Ctr, Dept Pediat, Boulder, CO 80309 USA
[8] Denver Hlth, Div Ambulatory Pediat, Denver, CO USA
[9] Colorado Fdn Med Care, Denver, CO USA
关键词
antibiotics; patient education; physician practice patterns; quality improvement;
D O I
10.1111/j.1475-6773.2005.00344.x
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
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.
引用
收藏
页码:101 / 116
页数:16
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