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    Impact of a 16-community trial to promote judicious antibiotic use in Massachusetts

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    Authors
    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
    Goldmann, Donald A.
    Platt, Richard
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    UMass Chan Affiliations
    Department of Psychiatry
    Meyers Primary Care Institute
    Department of Pediatrics
    Document Type
    Journal Article
    Publication Date
    2008-01-02
    Keywords
    Adolescent
    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
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    Link to Full Text
    http://dx.doi.org/10.1542/peds.2007-0819
    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
    DOI
    10.1542/peds.2007-0819
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/37038
    PubMed ID
    18166533
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1542/peds.2007-0819
    Scopus Count
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