Impact of a 16-community trial to promote judicious antibiotic use in Massachusetts
Finkelstein, Jonathan A. ; Huang, Susan S. ; Kleinman, Kenneth P. ; Rifas-Shiman, Sheryl L. ; Stille, Christopher J. ; Daniel, James ; Schiff, Nancy L. ; Steingard, Ron ; Soumerai, Stephen B. ; Ross-Degnan, Dennis ... show 2 more
Citations
Authors
Huang, Susan S.
Kleinman, Kenneth P.
Rifas-Shiman, Sheryl L.
Stille, Christopher J.
Daniel, James
Schiff, Nancy L.
Steingard, Ron
Soumerai, Stephen B.
Ross-Degnan, Dennis
Goldmann, Donald A.
Platt, Richard
Student Authors
Faculty Advisor
Academic Program
UMass Chan Affiliations
Document Type
Publication Date
Keywords
Age Factors
Anti-Bacterial Agents
Child
Child, Preschool
Cluster Analysis
Drug Prescriptions
*Drug Resistance, Microbial
Drug Utilization
Female
Health Education
Humans
Incidence
Intervention Studies
Male
Massachusetts
Probability
Reference Values
Respiratory Tract Infections
Risk Assessment
Severity of Illness Index
Sex Factors
Health Services Research
Pediatrics
Primary Care
Subject Area
Embargo Expiration Date
Link to Full Text
Abstract
OBJECTIVES: Reducing unnecessary antibiotic use, particularly among children, continues to be a public health priority. Previous intervention studies have been limited by size or design and have shown mixed results. The objective of this study was to determine the impact of a multifaceted, community-wide intervention on overall antibiotic use for young children and on use of broad-spectrum agents. In addition, we sought to compare the intervention's impact on commercially and Medicaid-insured children.
METHODS: We conducted a controlled, community-level, cluster-randomized trial in 16 nonoverlapping Massachusetts communities, studied from 1998 to 2003. During 3 years, we implemented a physician behavior-change strategy that included guideline dissemination, small-group education, frequent updates and educational materials, and prescribing feedback. Parents received educational materials by mail and in primary care practices, pharmacies, and child care settings. Using health-plan data, we measured changes in antibiotics dispensed per person-year of observation among children who were aged 3 to <72 >months, resided in study communities, and were insured by a participating commercial health plan or Medicaid.
RESULTS: The data include 223,135 person-years of observation. Antibiotic-use rates at baseline were 2.8, 1.7, and 1.4 antibiotics per person-year among those aged 3 to <24, 24 to <48, and 48 to <72 months, respectively. We observed a substantial downward trend in antibiotic prescribing, even in the absence of intervention. The intervention had no additional effect among children aged 3 to <24 months but was responsible for a 4.2% decrease among those aged 24 to <48 months and a 6.7% decrease among those aged 48 to <72 months. The intervention effect was greater among Medicaid-insured children and for broad-spectrum agents.
CONCLUSIONS: A sustained, multifaceted, community-level intervention was only modestly successful at decreasing overall antibiotic use beyond substantial secular trends. The more robust impact among Medicaid-insured children and for specific medication classes provides an argument for specific targeting of resources for patient and physician behavior change.
Source
Pediatrics. 2008 Jan;121(1):e15-23. Link to article on publisher's site