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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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| Published in: | Pediatrics (Evanston) 2008-01, Vol.121 (1), p.e15-e23 |
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| creator | 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 |
| description | 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 |
| doi_str_mv | 10.1542/peds.2007-0819 |
| format | article |
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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.
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.
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.]]></description><identifier>ISSN: 0031-4005</identifier><identifier>EISSN: 1098-4275</identifier><identifier>DOI: 10.1542/peds.2007-0819</identifier><identifier>PMID: 18166533</identifier><identifier>CODEN: PEDIAU</identifier><language>eng</language><publisher>United States: Am Acad Pediatrics</publisher><subject>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</subject><ispartof>Pediatrics (Evanston), 2008-01, Vol.121 (1), p.e15-e23</ispartof><rights>Copyright American Academy of Pediatrics Jan 2008</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c465t-c3dde689edb66ebfaccdcfea40d14bb0a53fa339f08e5e787fa921f16b366b413</citedby><cites>FETCH-LOGICAL-c465t-c3dde689edb66ebfaccdcfea40d14bb0a53fa339f08e5e787fa921f16b366b413</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18166533$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Finkelstein, Jonathan A</creatorcontrib><creatorcontrib>Huang, Susan S</creatorcontrib><creatorcontrib>Kleinman, Ken</creatorcontrib><creatorcontrib>Rifas-Shiman, Sheryl L</creatorcontrib><creatorcontrib>Stille, Christopher J</creatorcontrib><creatorcontrib>Daniel, James</creatorcontrib><creatorcontrib>Schiff, Nancy</creatorcontrib><creatorcontrib>Steingard, Ron</creatorcontrib><creatorcontrib>Soumerai, Stephen B</creatorcontrib><creatorcontrib>Ross-Degnan, Dennis</creatorcontrib><creatorcontrib>Goldmann, Donald</creatorcontrib><creatorcontrib>Platt, Richard</creatorcontrib><title>Impact of a 16-Community Trial to Promote Judicious Antibiotic Use in Massachusetts</title><title>Pediatrics (Evanston)</title><addtitle>Pediatrics</addtitle><description><![CDATA[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 <72 months, resided in study communities, and were insured by a participating commercial health plan or Medicaid.
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.
A sustained, multifaceted, community-level intervention was only modestly successful at decreasing overall antibiotic use beyond substantial secular trends. 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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 <72 months, resided in study communities, and were insured by a participating commercial health plan or Medicaid.
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.
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.]]></abstract><cop>United States</cop><pub>Am Acad Pediatrics</pub><pmid>18166533</pmid><doi>10.1542/peds.2007-0819</doi><oa>free_for_read</oa></addata></record> |
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| 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 |
| title | Impact of a 16-Community Trial to Promote Judicious Antibiotic Use in Massachusetts |
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