Article Figures & Data
Tables
Characteristic Total Intervention Control P Value Note: Numbers and percentages vary between items due to differing numbers of missing values. a Fisher’s exact test. Number responding 168 98 70 Specialty, No. (%) .05a Pediatrics 123 (74) 66 (67) 57 (81) Family medicine 41 (25) 30 (31) 11 (16) Other 2 (1) 1 (1) 1 (1) Male 106 (63) 68 (69) 38 (55) .06 Direct patient care, hours per week (≥25), No. (%) 151 (92) 87 (91) 64 (93) .63 Percentage of patients ensured by Medicaid, No. (%) .93a 0%–20% 71 (43) 44 (46) 27 (40) 21%–40% 68 (41) 37 (39) 31 (46) 41%–60% 19 (12) 11 (11) 8 (12) 61%–80% 3 (2) 2 (2) 1 (1) 81%–100% 3 (2) 2 (2) 1 (1) Years in practice, mean (SD) 18 (10) 18 (11) 17 (10) .60 Source Total No (%) Intervention No (%) Control No (%) P Value AAFP = American Academy of Family Physicians; AAP = American Academy of Pediatrics; CDC = Centers for Disease Control and Prevention; Mass = Massachusetts; REACH = REducing Antibiotics in CHildren. Note: Numbers and percentages vary between items due to differing numbers of missing values. REACH Mass 92 (55) 89 (91) 3 (4) <.0001 Professional journals 154 (92) 89 (92) 65 (93) .64 CDC 93 (55) 49 (50) 44 (63) .10 AAP 125 (74) 67 (68) 58 (83) .03 Other organizations (primarily AAFP) 23 (14) 15 (15) 8 (11) .47 Lay press 64 (38) 34 (35) 30 (43) .28 Pharmaceutical companies 45 (27) 25 (26) 20 (29) .66 Professional meetings 106 (63) 63 (64) 43 (61) .71 Question Total Intervention Control P Value Note: All figures are numbers (percentages) of responses of “moderately” or “a lot” on a 4-point scale, except where noted in the last row. Numbers and percentages vary between items due to differing numbers of missing values. Is bacterial antibiotic resistance a significant problem for children in your community? No. (%) 95 (57) 58 (60) 37 (54) .43 Does antibiotic resistance currently have an impact on your own prescribing choices or patient outcomes? No. (%) 109 (66) 63 (65) 46 (68) .72 Is parental demand for antibiotics a significant issue in your practice? No. (%) 76 (46) 42 (43) 34 (50) .40 Do you believe antibiotics are overused in primary care practice for children? No. (%) 144 (87) 84 (88) 60 (87) .92 How much, as a percentage, do you believe you could decrease your anti-biotic prescribing without changing the outcome? Mean % (SD) 19 (12) 18 (9) 20 (15) .38 Practice Total No. (%) Intervention No. (%) Control No. (%) P Value AOM = acute otitis media. Note: Numbers and percentages vary between items due to differing numbers of missing values. a Fisher’s exact test. During the past 3 years, has antibiotic use in your practice .03a Decreased 113 (68) 73 (75) 40 (58) Remained the same 49 (30) 23 (24) 26 (38) Increased 4 (2) 1 (1) 3 (4) During the past 3 years, has parental demand for inappropriate antibiotics in your practicea .19 Decreased 94 (57) 61 (63) 33 (49) Remained the same 59 (36) 30 (31) 29 (43) Increased 12 (7) 6 (6) 6 (9) Use watchful waiting for uncomplicated AOM in children 2 years old or greater “occasionally” or more 100 (63) 64 (67) 36 (56) .18 Use high-dose amoxicillin (75–90 mg/kg/d) for initial antibiotic treatment of AOM among otherwise healthy children under 2 years old (“most of the time” or “always”) 68 (41) 40 (41) 28 (41) .99a Prescribe antibiotics for pharyngitis before test results known ≤10% of the time 148 (90) 89 (93) 59 (87) .21 Days of symptoms before prescribing antibiotics for sinusitis in a 3-year-old child with cough but no fever ≥14 or “never” 96 (58) 56 (58) 40 (57) .88 Material Reporting Yes No. (%) REACH = REducing Antibiotics in CHildren. Note: Percentages may vary because of missing responses for some items. Attended dinner meeting 33 (38) Received “REACH notes” 79 (93) Among those reporting “yes,” those who read them most/all of the time 57 (73) Received parent educational materials 80 (95) Among those reporting “yes” Displayed in waiting room sometimes/often 63 (80) Displayed in examination room sometimes/often 53 (67) Handed to parents by nurse sometimes/often 36 (46) Handed to parents by physician sometimes/often 48 (61) ER = emergency department. 1. Regarding parent brochures and pressure to prescribe antibiotics “I find patients reading them, and then I’ll walk into the room and they’ll actually confront me as if they’ve just had an epiphany, saying, ‘oh, I didn’t know that antibiotics weren’t useful for [some ear infections].…’ Patients grab the pamphlet and they read about it and then I don’t feel pressured at the end of the visit.” 2. Regarding simultaneous messages to multiple stakeholders “The best thing is to get in touch [with] pediatricians, family practice doctors, and the ER doctors and the community at the same time. I know that’s hard, but that’s a good way to do it.… So there should be consistency in the message that we give to the community.” 3. Regarding patient education “Every channel of education has to be sort of initiated so that whoever has a particular preference, their educational interest would be evoked. So it shouldn’t just be [patient pamphlets or anticipatory guidance]. It should be an all around effort of having every channel available, because as the awareness increases, then the educational efforts don’t need to be that intense.” 4. Regarding direct-to-consumer advertising “I think we should have it in some type of written form that parents can see, even on television.… Why can’t we advertise the appropriate use of antibiotic? Why can’t we use the same media that they use to tell every-one on television to take [brand-name medications] or whatever else they are advertising?”
Additional Files
Supplemental Appendix
Supplemental Appendix. Telephone Interview Script for Evaluation of REACH Mass Physicians
Files in this Data Supplement:
- Supplemental data: Appendix - PDF file, 3 pages, 104KB
The Article in Brief
Background The Centers for Disease Control and Prevention and other organizations have recommended that doctors in the United States reduce inappropriate prescribing of antibiotics. This article reports on the effectiveness of an educational program for doctors about antibiotic prescribing.
What This Study Found The program to promote cautious antibiotic prescribing reached its intended audience and was welcomed by doctors as a tool for parent education. According to participating doctors, the program had little influence on their attitudes and practices, but most report prescribing antibiotics appropriately. Doctors suggest that frequent repetition of brief, consistent messages to parents and doctors, brief handouts, and promotion in the mass media are effective ways to educate the public and the medical profession about antibiotic use.
Implications
- Educational campaigns that repeat brief, consistent reminders to multiple groups may be most effective at assuring appropriate use of antibiotics.