Table 2.
Quasi Experimental Studies Demonstrating Decreased Antibiotic Prescription Rates in Response to Patient- or Public- Centered Educational Interventions Compared to Control
| Location of Intervention (years observed) | Setting | Patient Education | Provider Education | Outcome Measure | Prescription Rate Change | |||
|---|---|---|---|---|---|---|---|---|
| Control | (Full) Intervention | Intervention Effect | P value (intervention effect compared to control) | |||||
| Denver-Boulder Colorado (1996–1998) [32] | MCO practices | Household mailings and office-based educational materials regarding self care, when to expect antibiotics, and harmful effects of antibiotics | Education and meetings about management of acute bronchitis and how to say “no” to patients, site-specific prescribing rates | Antibiotics for Adults with Acute Bronchitis | −5% (P = 0.68) | −26% (P = 0.003) | Not reported | 0.02 |
| Denver, Colorado (2000–2001) [29] | MCO Practices | Household and office-based educational materials including CDC materials regarding resistance and facts about treatments for respiratory infections | Prescribing profiles and practice guidelines | Antibiotics for Adults with Acute Bronchitis | − 10% (local control), − 6% (distant control) | −24% | Not reported |
0.006 (local control) < 0.002 (distant control) |
| Denver, Colorado (2002–2003) [30] | Community-wide | Media campaign with out-of-home advertising, office-based materials | Physician advocacy activities were mailed: postcards soliciting support, office materials, stethoscope clips | Antibiotic dispenses/1000 MCO members | Values not noted | −8.8% (P = 0.03) | Not reported | Not reported |
| Rural Alaska (1998–1999) [36] | Rural Communities | Villiage meetings, community fairs, high school classrooms, and news letters about respiratory infections and antibiotic resistance | Workshops for community health aids and physicians to review principles of appropriate use | Antibiotic Courses/person | −9.5% (P < 0.05) | −31% (P < 0.01) | Not reported | Not reported |
| Sacramento, California (1998–1999) [37] | MCO (clinic, urgent care) | Office-based materials and newsletter regarding indications for antibiotics, bacterial resistance, how to prevent infection, and how to take antibiotics | Clinical pharmacists presented CDC Judicious Use principles to physicians, nurse practitioners, and physician assistants. Provider-specific antibiotic prescribing profiles and cold kits were included. | Antibiotics for Acute Bronchitis | 0% | −20% (P = 0.001) | Not reported | Not reported |
| Knox County, Tennessee (1997–1998) [43] | Community-wide | Printed materials and public media regarding indications for antibiotics | Lectures by a CDC physician and other presentations, prescribing guidelines, newsletters | Children < 15 years old (antibiotics/person-year) | −8% | −19% | − 11% (95%CI[− 8,-14%]) | < 0.001 |
| Utah (2001) [44] | Rural Community | Office-based informational brochures, media campaign about antibiotic resistance | Small group sessions overviewing antibiotic resistance and appropriate antibiotic use, algorithms | Upper respiratory tract infections treated with an antibiotic | −1.5% (P = 0.047) | − 15.6% (P = 0.002) | Not reported | 0.006 |
| Price, Rusk, Lincoln Counties, Wisconsin (1997) [24] | Community-wide | CDC pamphlets and posters distributed to clinics, pharmacies, child care facilities, schools | Grand rounds and small-group meetings regarding judicious use for pediatric respiratory infections, practice guidelines, CDC fact sheets | Solid antibiotic prescriptions/clinician | −8% (P = 0.934) | − 19% (P < 0.001) | − 11% | 0.042 |
| Liquid antibiotic prescriptions/clinician | 12% (P = 0.064) | −11% (P = 0.064) | −23% | 0.019 | ||||