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Studies suggest that large-scale strategies may be needed to reduce overuse of antibiotics in U.S. communities

Antibiotic resistance among many community-acquired bacterial pathogens is a growing public health problem. While recent studies suggest that agriculture is the largest source of exposure to antibiotics, the health care system is also viewed as a contributor. Hence, most efforts to reduce unnecessary antibiotic use, which fuels this problem, have focused on office-level educational programs for clinicians and patients.

Two new studies, supported by the Agency for Healthcare Research and Quality, suggest that community-level approaches may boost the effectiveness of this approach. The first study (HS10247) found that an office-based intervention to promote judicious antibiotic prescribing reached its intended audience, but physicians felt that reinforcement of the messages via mass media would enhance its effectiveness. A second study (HS13001) linked a low-cost mass media campaign with reduced antibiotic use in the community. While these studies show declines in the prescribing of antibiotics, they do not claim to affect rates of antibiotic resistance. Both studies are briefly summarized here.

Stille, C.J., Rifas-Shiman, S.L., Kleinman, K., and others (2008, May-June). "Physician responses to a community-level trial promoting judicious antibiotic use." Annals of Family Medicine 6(3), pp. 206-212.

This study found that the message to reduce unnecessary use of antibiotics, promoted through multiple methods directed at both physicians and parents, reached physician audiences in those communities. These materials were also welcomed by physicians as a tool for parent education. The researchers surveyed 168 physicians in 16 Massachusetts communities in a 3-year REACH (Reducing Antibiotics in Children) trial to promote judicious antibiotic use for respiratory tract infections that are caused by viruses, which cannot be treated by antibiotics. Physicians in intervention communities received locally endorsed guidelines, group educational sessions, and biweekly newsletters on judicious antibiotic use. Parents simultaneously received materials in physicians' offices and by mail.

The researchers mailed a physician survey and interviewed them after the educational campaign to assess its impact. More intervention than control physicians (who received no educational materials or training) reported decreased antibiotic prescribing from 2000 to 2003 (75 vs. 58 percent), but there were no differences between groups in knowledge, attitudes, or behaviors favoring judicious antibiotic use. Both groups expressed concern about antibiotic resistance and reported room to reduce their own prescribing. Interviewed intervention physicians believed that frequent repetition of short, consistent messages to both parents and physicians, brief physician and parent handouts on specific topics, and dissemination of the message by the mass media were the most effective way to improve judicious antibiotic use.

Gonzales, R., Corbett, K.K., Wong, S., and others (2008, June). "'Get smart Colorado': Impact of a mass media campaign to improve community antibiotic use." Medical Care 46(6), pp. 597-605.

A mass media campaign for appropriate antibiotic use that targeted mothers of young children in a large metropolitan community reduced community-level antibiotic use in a cost-efficient manner, according to this study. The researchers examined the impact of a "Get Smart Colorado" campaign. The campaign consisted of paid outdoor advertising and media and physician advocacy and ran between November 2002 and February 2003. The researchers measured antibiotics dispensed per 1,000 persons or managed care enrollees, and the proportion of office visits in which antibiotics were received during the 10 to 12 months before and after the campaign.

Following the mass media campaign, there was a 3.8 percent net decrease in retail pharmacy antibiotic dispensings per 1,000 persons and an 8.8 percent net decrease in managed care-associated antibiotic dispensings per 1,000 members in the mass media community. Most of the decline was among children and corresponded with a decline in the number of pediatric office visits in which patients received antibiotics. Finally, the campaign seemed to be cost-saving. The monetary savings per 1,000 pediatric managed care members was over $5,500. Overall, the researchers estimated a savings of over $7 per managed care member per year. The "Get Smart Colorado" campaign is the first example of a wide-scale mass media campaign to affect office visit and antibiotic use at the community level in the United States.

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