Education

• No intervention; observational study.

Outcome:

• Communication techniques used by providers that were associated with prescribing antibiotics for acute respiratory tract infections (ARTIs) and with parent visit satisfaction

• Cross-sectional study with parent and provider post-visit surveys

Participants

• Pediatric providers

• Parents of children (6 months to 10 years old) presenting with complaints consistent with ARTIs

Setting

• 10 pediatric practices in the United States (Washington)

• 1,284 parents

• Communication techniques using recommendations for treating symptoms were associated with lower risk of antibiotic prescribing for ARTIs.

• Communication techniques that combined explanations of why antibiotics are not needed with recommendations for treating symptoms were associated with lower risk of antibiotic prescribing and higher parental visit satisfaction.

• No intervention; observational study.

Outcome

• Physician perception of parental pressure for antibiotics

• Physician-perceived pressure to prescribe antibiotics

• Parental visit-specific satisfaction

• Qualitative study involving pre- and post-visit survey

Participants

• Physicians and eligible parents who attended acute care visits for their child

Setting

• 2 private practice pediatric clinics in the United States (California)

• Half of parents expected antibiotics before the visit, but only 1% of visits verbally requested them.

• Physicians perceived parental expectation for antibiotics 34% of the time without a direct request by parents for antibiotics.

• Offering a contingency plan of possibly receiving future antibiotics if their child did not improve was associated with higher satisfaction among parents who expected but did not receive antibiotics.

• No intervention; observational study.

Outcomes:

• Patient and parent knowledge and attitudes about antibiotics and adverse drug events (ADEs) from antibiotics

Computer assisted telephone focus groups Participants

• Adult patients and mothers of young children

Setting

• United States

• Few mothers were familiar with severe antibiotic-associated ADEs.

• Most mothers felt strongly that information about severe ADEs should be shared with parents at the time an antibiotic is prescribed.

• Adult patients did not believe that antibiotic-associated ADEs was a significant issue.

• Adult patients may be less receptive about receiving information about antibiotic-associated ADEs.

• Multifaceted clinician education, including communication skills, targeting antibiotic prescribing versus standard care

• Audit and feedback of practice antibiotic dispensing data

Outcomes

• Primary: total number of antibiotics dispensed per 1000 patients by practice

Secondary:

• Return visits and hospital admissions for respiratory tract infections, and cost

• Randomized controlled trial

Participants

• General practitioners

Setting

• General practices in the United Kingdom (Wales)

• A 4.2% reduction in total antibiotic prescribing was observed in the intervention group compared with controls in one year (p = 0.02).

• No differences in hospital admissions or return visits for respiratory tract infections were observed between the intervention and control groups.

• 5.5% non-significant decreased in antibiotic dispensing cost in intervention group compared with controls

• Clinician education targeting antibiotic prescribing for acute respiratory tract infections (ARTIs)

• Posters directed at providers placed in exam rooms

• Patient education through an interactive computerized education (ICE) module.

• Patients who chose not to participate in the ICE were considered to have been exposed to the “limited” intervention

Outcomes

Proportion of patients with ARTIs who received antibiotics

• Prospective, nonrandomized controlled trial

Participants

• Adults with ARTIs

Setting

• Urban urgent care clinic serving the major public hospital in the United States (Colorado)

• Antibiotic prescribing for patients diagnosed with acute bronchitis decreased from 58% to 30% in those exposed to the limited intervention, and to 24% among those exposed to full intervention (p<0.001 compared with baseline).

• Antibiotic prescribing for nonspecific upper respiratory tract infections decreased from 14% to 3% in those exposed to the limited intervention, and to 1% among those exposed to the full intervention (p<0.001 compared with baseline).

• Clinician education using interactive and case-based learning targeting antibiotic prescribing for upper respiratory tract infections (URIs)

Outcomes

• Improvements in antibiotic prescribing for URIs

• Prospective nonrandomized controlled trial

Participants

• Primary care physicians

Setting

• Four primary care clinics within a staff model health maintenance organization in the United States (Michigan)

• Antibiotic prescribing in the intervention group decreased 24.6% for both pediatric and adult medicine clinicians.

• In the control group, no significant decline in antibiotic prescribing was observed.

• Academic detailing on antibiotic prescribing for respiratory tract infections

• Clinician education

• Audit and feedback

Outcomes

• Improvements in antibiotic prescribing for respiratory tract infections

• Improvements in broad-spectrum antibiotic prescribing

• Cluster randomized controlled trial

Participants

• General practitioners

Setting

• General practice clinics in Norway

• Reductions in antibiotic prescribing were observed in the intervention group compared with the control groups (odds ratio 0.72, 95% confidence interval 0.61 to 0.84).

• Prescribing of non-penicillin V drugs also decreased in the intervention arm (0.64, 0.49 to 0.82).