Abstract
Reducing unnecessary antibiotic use, particularly among children, continues to be a public health priority. Previous intervention studies have been limited by size or design and have shown mixed results. The objective of this study was to determine the impact of a multifaceted, community-wide intervention on overall antibiotic use for young children and on use of broad-spectrum agents. In addition, we sought to compare the intervention's impact on commercially and Medicaid-insured children. We conducted a controlled, community-level, cluster-randomized trial in 16 nonoverlapping Massachusetts communities, studied from 1998 to 2003. During 3 years, we implemented a physician behavior-change strategy that included guideline dissemination, small-group education, frequent updates and educational materials, and prescribing feedback. Parents received educational materials by mail and in primary care practices, pharmacies, and child care settings. Using health-plan data, we measured changes in antibiotics dispensed per person-year of observation among children who were aged 3 to <72 months, resided in study communities, and were insured by a participating commercial health plan or Medicaid. The data include 223,135 person-years of observation. Antibiotic-use rates at baseline were 2.8, 1.7, and 1.4 antibiotics per person-year among those aged 3 to <24, 24 to <48, and 48 to <72 months, respectively. We observed a substantial downward trend in antibiotic prescribing, even in the absence of intervention. The intervention had no additional effect among children aged 3 to <24 months but was responsible for a 4.2% decrease among those aged 24 to <48 months and a 6.7% decrease among those aged 48 to <72 months. The intervention effect was greater among Medicaid-insured children and for broad-spectrum agents. A sustained, multifaceted, community-level intervention was only modestly successful at decreasing overall antibiotic use beyond substantial secular trends. The more robust impact among Medicaid-insured children and for specific medication classes provides an argument for specific targeting of resources for patient and physician behavior change.
Highlights
The more robust impact among Medicaid-insured children and for specific medication classes provides an argument for specific targeting of resources for patient and physician behavior change
Dr Finkelstein had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis; Drs Finkelstein, Huang, and Kleinman drafted the manuscript; Dr Kleinman and Ms Rifas-Shiman were responsible for statistical analysis; Drs Kleinman, Huang, Stille, Steingard, Soumerai, Ross-Degnan, Goldmann, and Platt, Ms RifasShiman, Mr Daniel, and Ms Schiff critically reviewed the manuscript; Drs Finkelstein, Kleinman, Soumerai, Ross-Degnan, Stille, Goldmann, and Platt and Mr Daniel were responsible for study concept and design; Drs Finkelstein, Huang, Platt, and Steingard, Mr Daniel, and Ms Schiff acquired the data; and Drs Finkelstein, Huang, Kleinman, Stille, Steingard, Soumerai, Ross-Degnan, Goldmann, and Platt, Ms Rifas-Shiman, and Ms Schiff were responsible for analysis and interpretation of data
Antibiotic resistance continues to be a threat to public health,[41,42] with high rates of human antibiotic use likely to be a substantial contributor.[10,11]
Summary
Among children, continues to be a public health priority. Previous intervention studies have been limited by size or design and have shown mixed results. The objective of this study was to determine the impact of a multifaceted, community-wide intervention on overall antibiotic use for young children and on use of broad-spectrum agents. We sought to compare the intervention’s impact on commercially and Medicaidinsured children
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