Abstract
BACKGROUND: Inappropriate use of antimicrobials to treat acute upper respiratory tract infections (URIs), which usually have a viral etiology, contributes to emergence and spread of antimicrobial resistance in Streptococcus pneumoniae and other human bacterial pathogens. OBJECTIVE: To reduce antimicrobial use for management of acute URIs in adult and pediatric patients. DESIGN: Prospective, nonrandomized, controlled trial. SETTING: Four primary care clinics within a staff model HMO in Detroit, Mich. PARTICIPANTS: Twenty-one primary care physicians at clinics where the educational intervention was implemented, and 9 primary care physicians at control clinics where no educational programs were implemented. MEASUREMENTS: Antibiotic prescribing for acute URIs during the baseline and study years among the intervention and control groups. RESULTS: A generalized linear mixed-effects model was used and showed that antimicrobial prescribing among the intervention group physicians decreased 24.6% from the baseline to the postintervention period (P<.0001) for both pediatric and adult medicine physicians. From the baseline to the study period, there was no significant decline in rates of antimicrobial prescribing by the control group of physicians (pediatricians, P=.35; internists, P=.42). The rates of decline in antimicrobial prescribing differed significantly between the intervention and control groups (P<.0003 for pediatricians and P<.01 for Internists). CONCLUSIONS: An interactive, case-based educational program for physicians and their staff proved effective for reducing unwarranted prescribing of antibiotics in the treatment of URIs by primary care physicians in a Medicaid HMO setting.