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Cited by 118Antibiotic Use and ResistanceHealthcare cost, quality, practicesPharmaceutical Practices and Patient Outcomes

Cluster-Randomized Trial to Improve Antibiotic Use for Adults With Acute Respiratory Infections Treated in Emergency Departments

Metlay, Joshua P., Camargo, Carlos A., MacKenzie, Thomas, McCulloch, Charles, Maselli, Judith, Levin, Sara K., Kersey, Ayanna, Gonzales, Ralph·2007·Annals of Emergency Medicine
DOI 10.1016/j.annemergmed.2007.03.022
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Abstract

Study objective We evaluate the effectiveness of an educational program in hospital emergency departments (EDs) targeting reduction in antibiotic overuse for acute respiratory tract infections.Methods Sixteen hospitals participated in the cluster randomized trial, selecting a Veterans Administration (VA) and non-VA hospital within each of 8 metropolitan regions. Intervention sites received performance feedback, clinician education, and patient educational materials, including an interactive computer kiosk located in the waiting room. Medical records were reviewed at each site during the baseline year 1 and intervention year 2. The primary measure of effect was the percentage of visits for upper respiratory tract infections and acute bronchitis that were treated with antibiotics. Secondary outcomes, including return visits and visit satisfaction, were assessed by follow-up telephone interviews of patients. Alternating logistic regression models were used to adjust for baseline treatment rates, case mix differences, and provider characteristics.Results The adjusted antibiotic prescription level for upper respiratory tract infection/acute bronchitis visits was 47% for control sites and 52% for intervention sites in year 1. Antibiotic prescriptions at control sites increased by 0.5% between year 1 and year 2 (95% confidence interval -3% to 5%) and at intervention sites decreased by 10% (95% confidence interval -18% to -2%). There were no significant differences between control and intervention sites in the proportions of upper respiratory tract infection/bronchitis patients with return ED visits or in overall visit satisfaction.Conclusion Multidimensional educational interventions can reduce antibiotic overuse in the treatment of patients with upper respiratory tract infections and acute bronchitis in EDs. However, substantial antibiotic overuse persists despite this educational intervention.

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Authors
Metlay, J. P., Camargo, C. A., MacKenzie, T., McCulloch, C., Maselli, J., Levin, S. K., Kersey, A., & Gonzales, R.
Affiliations
  • Philadelphia VA Medical Center (US)
  • Massachusetts General Hospital (US)
  • Denver Health Medical Center (US)
  • University of California, San Francisco (US)
Corresponding author
Metlay, Joshua P.
ORCID
Venue
Annals of Emergency Medicine
Publisher
Elsevier BV
Published
2007-09
Volume
50
Issue
3
Pages
221-230
ISSN
0196-0644 (ISSN-L)
DOI
10.1016/j.annemergmed.2007.03.022
OpenAlex
W2107707046
Cited by
118
References
26
Citations by year
2026: 2 · 2025: 6 · 2024: 10 · 2023: 7 · 2022: 3 · 2021: 16 · 2020: 10 · 2019: 5 · 2018: 4 · 2017: 9 · 2016: 7 · 2015: 5 · 2014: 5 · 2013: 4 · 2012: 5
FWCI
5.91
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Annals of Emergency Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
Agency for Healthcare Research and Quality (1 R01 HS013915)
Topics
  • Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
  • Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords
antibiotic overuse, acute respiratory infections, upper respiratory tract infection, acute bronchitis, emergency department, clinician education, performance feedback, patient education, veterans, return visits, visitor satisfaction
MeSH terms
Acute Disease, Adolescent, Adult, Aged, Anti-Bacterial Agents, Emergency Service, Hospital, Female, Humans, Inservice Training, Male, Middle Aged, Patient Education as Topic, Practice Patterns, Physicians', Respiratory Tract Infections, Cluster Analysis, Logistic Models, Treatment Outcome, Patient Satisfaction

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