October 23, 2012

Pediatricians Aim To Cut Number Of Prescribed Antibiotics

Advil. Tylenol. Today’s society has more medications than ever. However, these pills may not be beneficial for individuals, especially children. Through quarterly monitoring and dialogue with doctors who were prescribing medications, the study was effectively able to reduce the incorrect use of antibiotics by about half in a large network of pediatric practices.

In the past, hospitals have worked to limit the overuse of antibiotics. The study is the first to look at the impact of antimicrobial stewardship intervention in an outpatient environment. The research findings were recently presented at Infectious Disease Week 2012 in San Diego.

“If you really want to impact antibiotic use, you have to do it with outpatient prescribing,” commented lead researcher Dr. Jeffrey Gerber, an assistant professor of pediatrics at Children’s Hospital of Philadelphia, in a prepared statement. “Our message is that targeting common conditions and intervening in the outpatient setting is doable.”

In particular, researchers looked at three different respiratory tract infections in children. 18 pediatric practices at Children’s Hospital agreed to participate in the study and resulted in the observation of the prescribing habits of 174 clinicians. Participants worked in a range of settings including rural, suburban, and urban communities. During the three-year study period, it included over 1.4 million office visits by 185,212 patients.

“Improving antibiotic use is a crucial public health goal and necessary given increasing antibiotic resistance,” remarked Dr. Daniel J. Diekema, a chair for the Society for Healthcare Epidemiology of America, in the statement. “This study shows that the same approaches we use in hospitals can also improve antibiotic use in clinics. The intervention isn’t complicated or high-tech, so it should be ‘scalable’ to large populations, where it could make a big difference in slowing resistance and preventing the complications of inappropriate antibiotic use.”

The scientists categorized the participants into two groups and the prescription habits were documented with the help of the network’s electronic health database. In the intervention group, clinicians were given a lunch-hour refresher that included information on the most recent prescribing guidelines as outlined by the American Academy of Pediatrics and the Infectious Disease Society of America. As well, each clinician in the intervention group was given a one-page update on a quarterly basis that listed updates on his or her prescribing habits. Participants were able to compare the guidelines with their own practice.

At the beginning of the study, 28 percent of children were receiving an inappropriate amount of antibiotics. However, following a year of regular prescribing evaluations, the participants in the intervention group showed that they reduced the number of 14 percent. The control group only dropped to 23 percent.

“The impact in the intervention group was much better than we thought it would be,” continued Gerber in the statement. “It shows that getting people up to speed and providing simple reminders are helpful. It also shows that you can leverage electronic health records to put together a relatively low- maintenance system to improve prescribing.”

The researchers want to continue the study and determine how effective the intervention was. They plan to study whether the clinicians return to old habits. They note that clinicians may feel pressured to prescribe medications when they are under a time-deadline and a family demands that a child be given antibiotics.

“We need to know what the important piece of our intervention was, whether the education or the feedback reports,” concluded Gerber in the statement. “What we’re ultimately hoping is that by improving adherence to prescribing guidelines, we changed the level of treatment success while reducing unnecessary exposure to broad-spectrum antibiotics.”

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