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dc.contributor.authorFinkelstein, Jonathan A.
dc.contributor.authorHuang, Susan S.
dc.contributor.authorKleinman, Kenneth P.
dc.contributor.authorRifas-Shiman, Sheryl L.
dc.contributor.authorStille, Christopher J.
dc.contributor.authorDaniel, James
dc.contributor.authorSchiff, Nancy L.
dc.contributor.authorSteingard, Ron
dc.contributor.authorSoumerai, Stephen B.
dc.contributor.authorRoss-Degnan, Dennis
dc.contributor.authorGoldmann, Donald A.
dc.contributor.authorPlatt, Richard
dc.date2022-08-11T08:09:22.000
dc.date.accessioned2022-08-23T16:28:31Z
dc.date.available2022-08-23T16:28:31Z
dc.date.issued2008-01-02
dc.date.submitted2011-12-30
dc.identifier.citationPediatrics. 2008 Jan;121(1):e15-23. <a href="http://dx.doi.org/10.1542/peds.2007-0819">Link to article on publisher's site</a>
dc.identifier.issn0031-4005 (Linking)
dc.identifier.doi10.1542/peds.2007-0819
dc.identifier.pmid18166533
dc.identifier.urihttp://hdl.handle.net/20.500.14038/37038
dc.description.abstractOBJECTIVES: 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.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=18166533&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1542/peds.2007-0819
dc.subjectAdolescent
dc.subjectAge Factors
dc.subjectAnti-Bacterial Agents
dc.subjectChild
dc.subjectChild, Preschool
dc.subjectCluster Analysis
dc.subjectDrug Prescriptions
dc.subject*Drug Resistance, Microbial
dc.subjectDrug Utilization
dc.subjectFemale
dc.subjectHealth Education
dc.subjectHumans
dc.subjectIncidence
dc.subjectIntervention Studies
dc.subjectMale
dc.subjectMassachusetts
dc.subjectProbability
dc.subjectReference Values
dc.subjectRespiratory Tract Infections
dc.subjectRisk Assessment
dc.subjectSeverity of Illness Index
dc.subjectSex Factors
dc.subjectHealth Services Research
dc.subjectPediatrics
dc.subjectPrimary Care
dc.titleImpact of a 16-community trial to promote judicious antibiotic use in Massachusetts
dc.typeJournal Article
dc.source.journaltitlePediatrics
dc.source.volume121
dc.source.issue1
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/meyers_pp/424
dc.identifier.contextkey2426080
html.description.abstract<p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p>
dc.identifier.submissionpathmeyers_pp/424
dc.contributor.departmentDepartment of Psychiatry
dc.contributor.departmentMeyers Primary Care Institute
dc.contributor.departmentDepartment of Pediatrics
dc.source.pagese15-23


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