Impact of a 16-Community Trial to Promote Judicious Antibiotic Use in Massachusetts

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 interv...

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Bibliographic Details
Published in:Pediatrics (Evanston) 2008-01, Vol.121 (1), p.e15-e23
Main Authors: Finkelstein, Jonathan A, Huang, Susan S, Kleinman, Ken, Rifas-Shiman, Sheryl L, Stille, Christopher J, Daniel, James, Schiff, Nancy, Steingard, Ron, Soumerai, Stephen B, Ross-Degnan, Dennis, Goldmann, Donald, Platt, Richard
Format: Article
Language:English
Subjects:
Adolescent
Age Factors
Anti-Bacterial Agents - administration & dosage
Antibiotics
Behavior modification
Child
Child, Preschool
Childrens health insurance programs
Clinical trials
Cluster Analysis
Drug Prescriptions - statistics & numerical data
Drug Resistance, Microbial
Drug therapy
Drug Utilization - statistics & numerical data
Female
Health Education - organization & administration
Humans
Incidence
Intervention
Male
Massachusetts - epidemiology
Pediatrics
Probability
Reference Values
Respiratory Tract Infections - diagnosis
Respiratory Tract Infections - drug therapy
Respiratory Tract Infections - epidemiology
Risk Assessment
Severity of Illness Index
Sex Factors
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Summary: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. 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
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.2007-0819