Address correspondence to: Ralph Gonzales, M.D., M.S.P.H., Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, 3333 California St., Box 1211, San Francisco, CA 94118. Kitty K. Corbett, Ph.D., M.P.H., is with Department of Anthropology, University of Colorado, Denver. Kitty K. Corbett, Ph.D., M.P.H., Bonnie A. Leeman-Castillo, M.S., Carol A. Darr, B.S., are with Health and Behavioral Sciences Program, University of Colorado, Denver. Karen Kafadar, Ph.D., is with Department of Mathematics, University of Colorado, Denver. Judith Glazner, M.S., is with Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center. Angela Sauaia, M.D., Ph.D., is with Division of Health Care Policy and Research, University of Colorado Health Sciences Center. Shale Wong, M.D., M.S.P.H., is with Department of Pediatrics, University of Colorado Health Sciences Center and also with Division of Ambulatory Pediatrics, Denver Health, Denver. Kathleen Erbacher, M.P.A., is with Colorado Foundation for Medical Care, Denver.
The “Minimizing Antibiotic Resistance in Colorado” Project: Impact of Patient Education in Improving Antibiotic Use in Private Office Practices
Article first published online: 21 JAN 2005
Health Services Research
Volume 40, Issue 1, pages 101–116, February 2005
How to Cite
Gonzales, R., Corbett, K. K., Leeman-Castillo, B. A., Glazner, J., Erbacher, K., Darr, C. A., Wong, S., Maselli, J. H., Sauaia, A. and Kafadar, K. (2005), The “Minimizing Antibiotic Resistance in Colorado” Project: Impact of Patient Education in Improving Antibiotic Use in Private Office Practices. Health Services Research, 40: 101–116. doi: 10.1111/j.1475-6773.2005.00344.x
- Issue published online: 21 JAN 2005
- Article first published online: 21 JAN 2005
- patient education;
- physician practice patterns;
- quality improvement
Objective. To assess the marginal impact of patient education on antibiotic prescribing to children with pharyngitis and adults with acute bronchitis in private office practices.
Data Sources/Study Setting. Antibiotic prescription rates based on claims data from four managed care organizations in Colorado during baseline (winter 2000) and study (winter 2001) periods.
Study Design. A nonrandomized controlled trial of a household and office-based patient educational intervention was performed. During both periods, Colorado physicians were mailed antibiotic prescribing profiles and practices guidelines as part of an ongoing quality improvement program. Intervention practices (n=7) were compared with local and distant control practices.
Data Collection/Extraction Methods. Office visits were extracted by managed care organizations using International Classification of Diseases-9-Clinical Modification codes for acute respiratory tract infections, and merged with pharmacy claims data based on visit and dispensing dates coinciding within 2 days.
Principal Findings. Adjusted antibiotic prescription rates during baseline and study periods increased from 38 to 39 percent for pediatric pharyngitis at the distant control practices, and decreased from 39 to 37 percent at the local control practices, and from 34 to 30 percent at the intervention practices (p=.18 compared with distant control practices). Adjusted antibiotic prescription rates decreased from 50 to 44 percent for adult bronchitis at the distant control practices, from 55 to 45 percent at the local control practices, and from 60 to 36 percent at the intervention practices (p<.002 and p=.006 compared with distant and local control practices, respectively).
Conclusions. In office practices, there appears to be little room for improvement in antibiotic prescription rates for children with pharyngitis. In contrast, patient education helps reduce antibiotic use for adults with acute bronchitis beyond that achieved by physician-directed efforts.