Reducing Antibiotic Prescribing in Primary Care for Respiratory Illness
Supported by the National Institutes of Health R01 HD084547-01 to Dr Mangione-Smith (principal investigator). Additional infrastructure funding was provided by the American Academy of Pediatrics and the Health Resources and Services Administration of the US Department of Health and Human Services under UA6MC15585, National Research Network to Improve Child Health.
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 toprescribing, 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.
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Kronman, M. P., Gerber, J. S., Grundmeier, R. W., Zhou, C., Robinson, J. D., Heritage, J., Stout, J., Burges, D., Hedrick, B., Warren, L., Shalowitz, M., Shone, L. P., Steffes, J., Wright, M., Fiks, A. G., & Mangione-Smith, R. (2020). Reducing Antibiotic Prescribing in Primary Care for Respiratory Illness. Pediatrics, 146(3), e20200038. https://doi.org/10.1542/peds.2020-0038