Decreasing antibiotic use in ambulatory practice - Impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults

Context The emergence and spread of antibiotic-resistant Streptococcus pneu moniae in US communities is due, in part, to the excessive use of antibioti cs for acute respiratory tract infections. Objective To decrease total antibiotic use for uncomplicated acute bronchit is in adults. Design Prospective, nonrandomized controlled trial, including baseline (Nov ember 1996-February 1997) and study (November 1997-February 1998) periods. Setting Four selected primary care practices belonging to a group-model hea lth maintenance organization in the Denver, Cole, metropolitan area, Participants Consecutive adults diagnosed as having uncomplicated acute bro nchitis. A total of 2462 adults were included at baseline and 2027 adults w ere included in the study. Clinicians included 56 physicians, 28 physician assistants or nurse practitioners, and 9 registered nurses. Intervention The full intervention site received household and office-based patient educational materials, as well as a clinician intervention consist ing of education, practice-profiling, and academic detailing, A limited int ervention site received only office-based educational materials, and contro l sites provided usual care. Main Outcome Measure Antibiotic prescriptions for uncomplicated acute bronc hitis during baseline and study periods. Results Antibiotic prescription rates for uncomplicated acute bronchitis we re similar at all 4 sites during the baseline period. During the study peri od, there was a substantial decline in antibiotic prescription rates at the full intervention site (from 74% to 48% [P=.003]), but not at the control and limited intervention sites (78% to 76% [P=.81] and 82% to 77% [P=.68], respectively). Compared with control sites, changes in nonantibiotic prescr iptions (inhaled bronchodilators, cough suppressants, and analgesics) were not significantly different for intervention sites. Return office visits (w ithin 30 days of the incident visit) for bronchitis or pneumonia did not ch ange significantly for any of the sites. Conclusions Antibiotic treatment of adults diagnosed as having uncomplicate d acute bronchitis can be safely reduced using a combination of patient and clinician interventions.