One size does not fit all: evaluating an intervention to reduce antibiotic prescribing for acute bronchitis

Abstract

BackgroundOveruse of antibiotics for upper respiratory tract infections (URIs) and acute bronchitis is a persistent and vexing problem. In the U.S., more than half of all patients with upper respiratory tract infections and acute bronchitis are treated with antibiotics annually, despite the fact that most cases are viral in etiology and are not responsive to antibiotics. Interventions aiming to reduce unnecessary antibiotic prescribing have had mixed results, and successes have been modest. The objective of this evaluation is to use mixed methods to understand why a multi-level intervention to reduce antibiotic prescribing for acute bronchitis among primary care providers resulted in measurable improvement in only one third of participating clinicians.MethodsClinician perspectives on print-based and electronic intervention strategies, and antibiotic prescribing more generally, were elicited through structured telephone surveys at high and low performing sites after the first year of intervention at the Geisinger Health System in Pennsylvania (n = 29).ResultsCompared with a survey on antibiotic use conducted 10 years earlier, clinicians demonstrated greater awareness of antibiotic resistance and how it is impacted by individual prescribing decisions—including their own. However, persistent perceived barriers to reducing prescribing included patient expectations, time pressure, and diagnostic uncertainty, and these factors were reported as differentially undermining specific intervention components’ effectiveness. An exam room poster depicting a diagnostic algorithm was the most popular strategy.ConclusionsFuture efforts to reduce antibiotic prescribing should address multi-level barriers identified by clinicians and tailor strategies to differences at individual clinician and group practice levels, focusing in particular on changing how patients and providers make decisions together about antibiotic use.

Antibiotic Resistance: A Primer and Call to Action

“…Clinicians, for example, vary in their knowledge of antibiotic resistance and perceived barriers to changing their prescription behaviors (Ackerman, Gonzales, Stahl, & Metlay, 2013). The public may not know that non-essential use of antibiotics is harmful to themselves and others.…”

Knowledge and Practices of Family and Emergency Physicians in Managing Nontraumatic Dental Conditions: A Case-based Survey

“…181 A survey of physicians by Ackerman et al found that persistent perceived barriers to reducing prescribing indeed included time pressures and diagnostic uncertainty. 61 And, in another study, 28% of family physicians admitted to prescribing antibiotics "several times a…”

“…28,40,44,54,55 It is apparent from the published literature that overprescribing of antibiotics by physicians is occurring within several areas of medicine in Canada [56][57][58] and globally. [59][60][61][62][63][64] Overprescribing of antibiotics has also been cited as being responsible for an increased incidence of allergic reactions-some of which may be fatal, drug toxicity, and an increased incidence of unfavourable interactions with other drugs taken by patients. 35,[65][66][67][68] Furthermore, since antibiotics only address symptoms of NTDCs and not the cause, the use of an antibiotic in the treatment of this type of emergency, even when necessary, often provides the patient with only temporary relief unless definitive dental care is also undertaken.…”

“…Overprescribing of antibiotics by physicians is occurring in several areas of patient care nationally [56][57][58] and globally. [59][60][61][62][63][64] In the US, the Centers for Disease Control and Prevention estimates that approximately 100 million antibiotic prescriptions are written by physicians each year, with approximately half of those appearing to be unnecessary. 180 Interestingly, Canada has one of the highest rates of use of antibiotics in the industrialized world, with a per capita rate twice that of the US.…”

Detection of respiratory viruses and bacteria in children using a twenty-two target reverse-transcription real-time PCR (RT-qPCR) panel

“…Although most ARIs are caused by viruses, up to 60% of young children with ARIs are treated with antibacterial agents. [2] While unnecessary antibiotic usage may be reduced through a number of approaches, including patient and physician education, [3,4] physicians are often pressured to treat with antibiotics.…”