Skip to main content

Advertisement

Log in

Optimizing antibiotic prescribing for acute respiratory tract infections in an urban urgent care clinic

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

OBJECTIVE: To decrease unnecessary antibiotic use for acute respiratory tract infections in adults in a point-of-service health care setting.

DESIGN: Prospective, nonrandomized controlled trial.

SETTING: An urban urgent care clinic associated with the major indigent care hospital in Denver, Colorado between October 2000 and April 2001.

PATIENTS/PARTICIPANTS: Adults diagnosed with acute respiratory tract infections (bronchitis, sinusitis, pharyngitis, and nonspecific upper respiratory infection). A total of 554 adults were included in the baseline period (October to December 2000) and 964 adults were included in the study period (January to April 2001).

INTERVENTIONS: A provider educational session on recommendations for appropriate antibiotic use recently published by the Centers for Disease Control and Prevention, and placement of examination room posters were performed during the last week of December 2000. Study period patients who completed a brief, interactive computerized education (ICE) module were classified as being exposed to the full intervention, whereas study period patients who did not complete the ICE module were classified as being exposed to the limited intervention.

MEASUREMENTS AND MAIN RESULTS: The proportion of patients diagnosed with acute bronchitis who received antibiotics decreased from 58% during the baseline period to 30% and 24% among patients exposed to the limited and full intervention, respectively (P<.001 for intervention groups vs baseline). Antibiotic prescriptions for nonspecific upper respiratory tract infections decreased from 14% to 3% and 1% in the limited- and full-intervention groups, respectively (P<.001 for intervention groups vs baseline).

CONCLUSION: Antibiotic use for adults diagnosed with acute respiratory tract infections can be reduced in a point-of-service health care setting using a combination of patient and provider educational interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Schappert SM. Ambulatory care visits of physician offices, hospital outpatient departments, and emergency departments, United States, 1995. Vital Health Stat 13. 1997;129:1–38.

    PubMed  Google Scholar 

  2. McCaig LF, Hughes JM. Trends in antimicrobial drug prescribing among office-based physicians in the United States. JAMA. 1995;273:214–9.

    Article  PubMed  CAS  Google Scholar 

  3. Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA. 1997;278:901–4.

    Article  PubMed  CAS  Google Scholar 

  4. Gonzales R, Maselli J, Sande MA. Trends in antimicrobial treatment of acute respiratory tract infections by United States primary care physicians, 1994–1999. J Gen Intern Med. 2001;16(suppl):196–7.

    Google Scholar 

  5. Gonzales R, Malone D, Sande MA. Estimating the amount and cost of ideal and excess antibiotic use for acute respiratory tract infections in the United States. Clin Infect Dis. 2001;33:757–62.

    Article  PubMed  CAS  Google Scholar 

  6. Gonzales R, Steiner JF, Lum A, Barrett PH Jr. Decreasing antibiotic use in ambulatory practice: impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults. JAMA. 1999;281:1512–9.

    Article  PubMed  CAS  Google Scholar 

  7. Finkelstein JA, Davis RL, Dowell SF, et al. Reducing antibiotic use in children: a randomized trial in 12 practices. Pediatrics. 2001;108:1–7.

    Article  PubMed  CAS  Google Scholar 

  8. Poses RM, Cebul RD, Wigton RS. You can lead a horse to water-improving physicians’ knowledge of probabilities may not affect their decisions. Med Decis Making. 1995;15:65–75.

    Article  PubMed  CAS  Google Scholar 

  9. Mainous AG III, Hueston WJ, Love MM, Evans ME, Finger R. An evaluation of statewide strategies to reduce antibiotic overuse. Fam Med. 2000;32:22–9.

    PubMed  Google Scholar 

  10. O’Connor PJ, Amundson G, Christianson J. Performance failure of an evidence-based upper respiratory infection clinical guideline. J Fam Pract. 1999;48:690–7.

    PubMed  CAS  Google Scholar 

  11. Gonzales R, Steiner JF, Maselli JH, Miller R, Lum A, Barrett PH Jr. Sustainability of an intervention strategy for reducing antibiotic use of uncomplicated acute bronchitis. J Gen Intern Med. 2000;15(suppl):118.

    Google Scholar 

  12. Hickner JM, Bartlett JG, Besser RE, Gonzales R, Hoffman JR, Sande MA. Principles of appropriate antibiotic use for acute rhinosinusitis in adults: background. Ann Intern Med. 2001;134:498–505.

    PubMed  CAS  Google Scholar 

  13. Buchanan BG, Moore JD, Forsythe DE, Carenini G, Ohlsson S, Banks G. An intelligent interactive system for delivering individualized information to patients. Artif Itell Med. 1995;7:117–54.

    Article  CAS  Google Scholar 

  14. Reis J, Wrestler F. Consumer attitudes toward computer-assisted self-care of the common cold. Patient Educ Couns. 1994;23:55–62.

    PubMed  CAS  Google Scholar 

  15. Kinzie MB, Schorling JB, Siegle M. Prenatal alcohol education for low-income women with interactive multimedia. Patient Educ Couns. 1993;21:51–60.

    Article  PubMed  CAS  Google Scholar 

  16. Gonzales R, Bartlett JG, Besser RE, Cooper RJ, Hickner JM, Hoffman JR, Sande MA. Principles of appropriate antibiotic use for treatment of uncomplicated acute bronchitis: background. Ann Intern Med. 2001;134:521–9.

    PubMed  CAS  Google Scholar 

  17. Cooper RJ, Hoffman JR, Bartlett JG, et al. Principles of appropriate antibiotic use for acute pharyngitis in adults: background. Ann Intern Med. 2001;134:509–17.

    PubMed  CAS  Google Scholar 

  18. Gonzales R, Bartlett JG, Besser RE, Hickner JM, Hoffman JR, Sande MA. Principles of appropriate antibiotic use for treatment of nonspecific upper respiratory tract infections in adults: background. Ann Intern Med. 2001;134:490–4.

    PubMed  CAS  Google Scholar 

  19. Hosmer DW, Lemeshow S. Applied Logistic Regression. New York: John Wiley and Sons; 1989.

    Google Scholar 

  20. White K, Barrett PH Jr, Price D, Maselli J, Gonzales R. Changing clinician behavior: characteristics associated with decreasing antibiotic prescribing in ambulatory practice. J Gen Intern Med. 2000;15(suppl):154.

    Google Scholar 

  21. Lewis D. Computer-based approaches to patient education: a review of the literature. J Am Med Inform Assoc. 1999;6:272–82.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Robert H. Harris MD.

Additional information

This work was supported by the Centers for Disease Control via Epidemiologist and Laboratory Capacity for Infectious Diseases Cooperative Agreement Program 95043/97020.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Harris, R.H., MacKenzie, T.D., Leeman-Castillo, B. et al. Optimizing antibiotic prescribing for acute respiratory tract infections in an urban urgent care clinic. J GEN INTERN MED 18, 326–334 (2003). https://doi.org/10.1046/j.1525-1497.2003.20410.x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1046/j.1525-1497.2003.20410.x

Key words

Navigation