Impact of a 16-community trial to promote judicious antibiotic use in Massachusetts
dc.contributor.author | Finkelstein, Jonathan A. | |
dc.contributor.author | Huang, Susan S. | |
dc.contributor.author | Kleinman, Kenneth P. | |
dc.contributor.author | Rifas-Shiman, Sheryl L. | |
dc.contributor.author | Stille, Christopher J. | |
dc.contributor.author | Daniel, James | |
dc.contributor.author | Schiff, Nancy L. | |
dc.contributor.author | Steingard, Ron | |
dc.contributor.author | Soumerai, Stephen B. | |
dc.contributor.author | Ross-Degnan, Dennis | |
dc.contributor.author | Goldmann, Donald A. | |
dc.contributor.author | Platt, Richard | |
dc.date | 2022-08-11T08:09:22.000 | |
dc.date.accessioned | 2022-08-23T16:28:31Z | |
dc.date.available | 2022-08-23T16:28:31Z | |
dc.date.issued | 2008-01-02 | |
dc.date.submitted | 2011-12-30 | |
dc.identifier.citation | Pediatrics. 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.issn | 0031-4005 (Linking) | |
dc.identifier.doi | 10.1542/peds.2007-0819 | |
dc.identifier.pmid | 18166533 | |
dc.identifier.uri | http://hdl.handle.net/20.500.14038/37038 | |
dc.description.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. | |
dc.language.iso | en_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.url | http://dx.doi.org/10.1542/peds.2007-0819 | |
dc.subject | Adolescent | |
dc.subject | Age Factors | |
dc.subject | Anti-Bacterial Agents | |
dc.subject | Child | |
dc.subject | Child, Preschool | |
dc.subject | Cluster Analysis | |
dc.subject | Drug Prescriptions | |
dc.subject | *Drug Resistance, Microbial | |
dc.subject | Drug Utilization | |
dc.subject | Female | |
dc.subject | Health Education | |
dc.subject | Humans | |
dc.subject | Incidence | |
dc.subject | Intervention Studies | |
dc.subject | Male | |
dc.subject | Massachusetts | |
dc.subject | Probability | |
dc.subject | Reference Values | |
dc.subject | Respiratory Tract Infections | |
dc.subject | Risk Assessment | |
dc.subject | Severity of Illness Index | |
dc.subject | Sex Factors | |
dc.subject | Health Services Research | |
dc.subject | Pediatrics | |
dc.subject | Primary Care | |
dc.title | Impact of a 16-community trial to promote judicious antibiotic use in Massachusetts | |
dc.type | Journal Article | |
dc.source.journaltitle | Pediatrics | |
dc.source.volume | 121 | |
dc.source.issue | 1 | |
dc.identifier.legacycoverpage | https://escholarship.umassmed.edu/meyers_pp/424 | |
dc.identifier.contextkey | 2426080 | |
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.submissionpath | meyers_pp/424 | |
dc.contributor.department | Department of Psychiatry | |
dc.contributor.department | Meyers Primary Care Institute | |
dc.contributor.department | Department of Pediatrics | |
dc.source.pages | e15-23 |