An evaluation of statewide strategies to reduce antibiotic overuse

<(Background)under bar>: The rapid increase of antibiotic resistance poses a significant threat to human health. Overuse of antibiotics has been linke d to rates of antibiotic resistance. This study assessed the utility of two common interventions-1) practice profiling and feedback and 2) patient edu cation materials-implemented to decrease antibiotic prescribing for pediatr ic upper respiratory infections (URIs). <(Methods)under bar>: Based on Medi caid regions in Kentucky, primary care physicians managing pediatric respir atory infections in Medicaid were randomized into four groups. Groups recei ved either 1) performance feedback only, 2) patient education materials onl y, 3) both feedback and education materials, or 4) no intervention. Partici pating physicians had their antibiotic prescribing assessed for the period of July 1, 1996 to November 30, 1997, with an intervention in June 1997. Th e study included 216 physicians and 124,092 episodes of care. <(Results)und er bar>: All groups increased in proportion of episodes with antibiotics be tween the pre-intervention and post-intervention periods. Prescribing in th e patient education group and the patient education and feedback group incr eased at a significantly lower rate than in the control group. Physicians d id not change their coding of illness to justify antibiotics after the inte rvention, and there was no significant generalization of effect of the pedi atric intervention on prescribing for adult URIs. <(Conclusions)under bar>: These interventions demonstrate little if any impact on promoting appropri ate antibiotic prescribing. Antibiotic prescribing for viral respiratory, i nfections continues to increase, suggesting concomitant increases in antibi otic resistance.