Reducing Antibiotic Prescribing in Primary Care for Respiratory Illness.
Acute Disease
Anti-Bacterial Agents
/ therapeutic use
Bronchitis
/ drug therapy
Chicago
Child
Child, Preschool
Communication
Confidence Intervals
Education, Distance
/ methods
Female
Humans
Inappropriate Prescribing
/ prevention & control
Infant
Intention to Treat Analysis
Logistic Models
Male
Odds Ratio
Otitis Media
/ drug therapy
Outpatients
Pediatric Nursing
/ education
Pediatricians
/ education
Pharyngitis
/ drug therapy
Primary Health Care
Program Development
Quality Improvement
Respiratory Tract Infections
/ drug therapy
Sinusitis
/ drug therapy
Streptococcal Infections
/ drug therapy
Journal
Pediatrics
ISSN: 1098-4275
Titre abrégé: Pediatrics
Pays: United States
ID NLM: 0376422
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
accepted:
15
05
2020
pubmed:
5
8
2020
medline:
8
10
2020
entrez:
5
8
2020
Statut:
ppublish
Résumé
One-third of outpatient antibiotic prescriptions for pediatric acute respiratory tract infections (ARTIs) are inappropriate. We evaluated a distance learning program's effectiveness for reducing outpatient antibiotic prescribing for ARTI visits. In this stepped-wedge clinical trial run from November 2015 to June 2018, we randomly assigned 19 pediatric practices belonging to the Pediatric Research in Office Settings Network or the NorthShore University HealthSystem to 4 wedges. Visits for acute otitis media, bronchitis, pharyngitis, sinusitis, and upper respiratory infection for children 6 months to <11 years old without recent antibiotic use were included. Clinicians received the intervention as 3 program modules containing online tutorials and webinars on evidence-based communication strategies and antibioti c prescribing, booster video vignettes, and individualized antibiotic prescribing feedback reports over 11 months. The primary outcome was overall antibiotic prescribing rates for all ARTI visits. Mixed-effects logistic regression compared prescribing rates during each program module and a postintervention period to a baseline control period. Odds ratios were converted to adjusted rate ratios (aRRs) for interpretability. Among 72 723 ARTI visits by 29 762 patients, intention-to-treat analyses revealed a 7% decrease in the probability of antibiotic prescribing for ARTI overall between the baseline and postintervention periods (aRR 0.93; 95% confidence interval [CI], 0.90-0.96). Second-line antibiotic prescribing decreased for streptococcal pharyngitis (aRR 0.66; 95% CI, 0.50-0.87) and sinusitis (aRR 0.59; 95% CI, 0.44-0.77) but not for acute otitis media (aRR 0.93; 95% CI, 0.83-1.03). Any antibiotic prescribing decreased for viral ARTIs (aRR 0.60; 95% CI, 0.51-0.70). This program reduced antibiotic prescribing during outpatient ARTI visits; broader dissemination may be beneficial.
Sections du résumé
BACKGROUND
One-third of outpatient antibiotic prescriptions for pediatric acute respiratory tract infections (ARTIs) are inappropriate. We evaluated a distance learning program's effectiveness for reducing outpatient antibiotic prescribing for ARTI visits.
METHODS
In this stepped-wedge clinical trial run from November 2015 to June 2018, we randomly assigned 19 pediatric practices belonging to the Pediatric Research in Office Settings Network or the NorthShore University HealthSystem to 4 wedges. Visits for acute otitis media, bronchitis, pharyngitis, sinusitis, and upper respiratory infection for children 6 months to <11 years old without recent antibiotic use were included. Clinicians received the intervention as 3 program modules containing online tutorials and webinars on evidence-based communication strategies and antibioti c prescribing, booster video vignettes, and individualized antibiotic prescribing feedback reports over 11 months. The primary outcome was overall antibiotic prescribing rates for all ARTI visits. Mixed-effects logistic regression compared prescribing rates during each program module and a postintervention period to a baseline control period. Odds ratios were converted to adjusted rate ratios (aRRs) for interpretability.
RESULTS
Among 72 723 ARTI visits by 29 762 patients, intention-to-treat analyses revealed a 7% decrease in the probability of antibiotic prescribing for ARTI overall between the baseline and postintervention periods (aRR 0.93; 95% confidence interval [CI], 0.90-0.96). Second-line antibiotic prescribing decreased for streptococcal pharyngitis (aRR 0.66; 95% CI, 0.50-0.87) and sinusitis (aRR 0.59; 95% CI, 0.44-0.77) but not for acute otitis media (aRR 0.93; 95% CI, 0.83-1.03). Any antibiotic prescribing decreased for viral ARTIs (aRR 0.60; 95% CI, 0.51-0.70).
CONCLUSIONS
This program reduced antibiotic prescribing during outpatient ARTI visits; broader dissemination may be beneficial.
Identifiants
pubmed: 32747473
pii: peds.2020-0038
doi: 10.1542/peds.2020-0038
pmc: PMC7461202
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Banques de données
ClinicalTrials.gov
['NCT02943551']
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : NICHD NIH HHS
ID : R01 HD084547
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 by the American Academy of Pediatrics.
Déclaration de conflit d'intérêts
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
Références
Pediatrics. 2011 Dec;128(6):1053-61
pubmed: 22065263
BMJ. 2014 Jan 24;348:f7450
pubmed: 24464277
Clin Infect Dis. 2015 May 1;60(9):1308-16
pubmed: 25747410
JAMA. 2016 Feb 9;315(6):562-70
pubmed: 26864410
JAMA. 2013 Jun 12;309(22):2345-52
pubmed: 23757082
Clin Infect Dis. 2012 Apr;54(8):e72-e112
pubmed: 22438350
JAMA. 2017 Oct 10;318(14):1391-1392
pubmed: 29049577
Pediatrics. 2013 Dec;132(6):1146-54
pubmed: 24249823
Soc Sci Med. 2005 Mar;60(5):949-64
pubmed: 15589666
Pediatrics. 2014 Jun;133(6):e1647-54
pubmed: 24819580
Lancet. 2013 Oct 5;382(9899):1175-82
pubmed: 23915885
JAMA. 1998 Nov 18;280(19):1690-1
pubmed: 9832001
Clin Infect Dis. 2020 Jan 16;70(3):370-377
pubmed: 30882145
Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S69-78
pubmed: 25222901
JAMA. 2016 May 3;315(17):1864-73
pubmed: 27139059
Acad Pediatr. 2018 Jul;18(5):577-580
pubmed: 29496546
BMJ. 2012 Feb 02;344:d8173
pubmed: 22302780
Ann Fam Med. 2015 May-Jun;13(3):221-7
pubmed: 25964399
Pediatrics. 2013 Apr;131(4):677-84
pubmed: 23509168
Arch Pediatr Adolesc Med. 2006 Sep;160(9):945-52
pubmed: 16953018
Pediatrics. 2014 Oct;134(4):e956-65
pubmed: 25225144
JAMA. 2014 Dec 17;312(23):2569-70
pubmed: 25317759
Clin Infect Dis. 2012 Nov 15;55(10):e86-102
pubmed: 22965026