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

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.

FIGURE 1

Flow diagram for subject enrollment, by group assignment.

FIGURE 2

Impact of a multimodal education intervention on antibiotic prescription rates for acute respiratory tract infections by diagnosis. ^*P < .001, limited and full intervention compared to baseline group; ^#P = .10, full intervention compared to limited group; ⁺P = .06, limited intervention compared to baseline group; ^**P value < .001 limited and full intervention compared to baseline group.