Kelley Meera, Massing Mark W, Young Joshua, Rogers Anne, Taylor Renee, Weiser Robert
Quality and Patient Safety, WakeMed Health and Hospitals, USA.
N C Med J. 2006 Jul-Aug;67(4):249-54.
Antimicrobial resistance in common respiratory tract pathogens is a growing public health threat, especially in the southeastern United States. The excessive use of antibiotics for common infections is a major contributing factor in the emergence of antibiotic resistance. We report results from a multi-site outpatient pilot project in North Carolina to reduce antibiotic prescriptions for acute nonbacterial upper respiratory tract infections (URIs).
Primary care practices were provided education and symptom therapy kits for patients with URIs, as an alternative to antibiotics, in a project to reduce the overuse of antimicrobial therapy The feasibility of this approach was evaluated with interviews and surveys. A methodology for claims-based evaluation of intervention efficacy in reduction of antibiotics use was developed as part of this project.
Of eight contacted practices, four agreed to participate and three participated fully. Physicians reported that symptom therapy kits were useful for patients with URIs and resulted in a meaningful change in antibiotic prescribing behaviors. A claims-based approach is a feasible and promising method to evaluate efficacy in subsequent post-pilot large-scale implementations.
Due to the small number of outpatient practices and the lack of controls in this pilot study, the efficacy of the intervention in reducing antibiotic use could not be determined.
Education combined with symptom therapy kits as an alternative to oral antibiotics is a feasible intervention that warrants additional studies to evaluate the efficacy of this approach in the reduction of antibiotic use for URIs.
常见呼吸道病原体的抗菌药物耐药性对公共卫生构成了日益严重的威胁，在美国东南部尤为如此。针对常见感染过度使用抗生素是抗生素耐药性出现的一个主要促成因素。我们报告了北卡罗来纳州一个多地点门诊试点项目的结果，该项目旨在减少急性非细菌性上呼吸道感染（URI）的抗生素处方。
在一个减少抗菌治疗过度使用的项目中，为URI患者的初级保健机构提供教育和症状治疗包，作为抗生素的替代方案。通过访谈和调查评估这种方法的可行性。作为该项目的一部分，开发了一种基于索赔的评估干预措施减少抗生素使用效果的方法。
在联系的8家机构中，4家同意参与，3家全面参与。医生报告说，症状治疗包对URI患者有用，并导致抗生素处方行为发生了有意义的变化。基于索赔的方法是一种可行且有前景的方法，可用于评估后续试点后大规模实施中的效果。
由于该试点研究中的门诊机构数量较少且缺乏对照，无法确定干预措施在减少抗生素使用方面的效果。
教育结合症状治疗包作为口服抗生素的替代方案是一种可行的干预措施，值得进一步研究以评估该方法在减少URI抗生素使用方面的效果。
