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Gonzales R, Steiner JF, Lum A, Barrett, Jr PH. Decreasing Antibiotic Use in Ambulatory Practice: Impact of a Multidimensional Intervention on the
Treatment of Uncomplicated Acute Bronchitis in Adults. JAMA. 1999;281(16):1512–1519. doi:10.1001/jama.281.16.1512
Author Affiliations: Division of General Internal Medicine (Drs Gonzales and Steiner), Department of Medicine (Drs Gonzales, Lum, and Steiner), University of Colorado Health Sciences Center, and Kaiser Permanente of Colorado (Drs Barrett and Lum), Denver.
Context The emergence and spread of antibiotic-resistant
Streptococcus pneumoniae in US communities is due, in part, to
the excessive use of antibiotics for acute respiratory tract
Objective To decrease total antibiotic use for uncomplicated
acute bronchitis in adults.
Design Prospective, nonrandomized controlled trial, including
baseline (November 1996-February 1997) and study (November
1997-February 1998) periods.
Setting Four selected primary care practices belonging to a
group-model health maintenance organization in the Denver, Colo,
Participants Consecutive adults diagnosed as having uncomplicated
acute bronchitis. A total of 2462 adults were included at baseline and
2027 adults were included in the study. Clinicians included 56
physicians, 28 physician assistants or nurse practitioners, and 9
Intervention The full intervention site received household and
office-based patient educational materials, as well as a clinician
intervention consisting of education, practice-profiling, and academic
detailing. A limited intervention site received only office-based
educational materials, and control sites provided usual care.
Main Outcome Measure Antibiotic prescriptions for uncomplicated
acute bronchitis during baseline and study periods.
Results Antibiotic prescription rates for uncomplicated acute
bronchitis were similar at all 4 sites during the baseline period.
During the study period, there was a substantial decline in antibiotic
prescription rates at the full intervention site (from 74% to 48%
[P=.003]), but not at the control and
limited intervention sites (78% to 76%
[P=.81] and 82% to 77%
[P=.68], respectively). Compared with
control sites, changes in nonantibiotic prescriptions (inhaled
bronchodilators, cough suppressants, and analgesics) were not
significantly different for intervention sites. Return office visits
(within 30 days of the incident visit) for bronchitis or pneumonia did
not change significantly for any of the sites.
Conclusions Antibiotic treatment of adults diagnosed as having
uncomplicated acute bronchitis can be safely reduced using a
combination of patient and clinician interventions.
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