Tools help curb inappropriate use of antibiotics, but not enough

Use of a printed or computer-based decision tool significantly cut the inappropriate prescription of antibiotics for acute bronchitis in research published in JAMA Internal Medicine. But the resulting prescription rate remained way too high, according to an accompanying editorial.

"Success is not reducing the antibiotic prescribing rate by 10 percent; success is reducing the antibiotic prescribing rate to 10 percent," wrote Jeffrey Linder, MD, of Brigham and Women's Hospital in Boston in an accompanying commentary.

Separate research has found the cough associated with acute bronchitis lasts longer than patients expect, possibly contributing to the over-prescription of antibiotics. That study, published in the Annals of Family Medicine, found that while patients expect the cough to last seven to nine days, it generally takes 18 days for the bronchial illness to run its course.

"If someone gets acute bronchitis and isn't better after four to five days, they may think they need to see a doctor and get an antibiotic. And when the first one doesn't work, they come back four or five days later for another," Dr. Mark Ebell, associate professor of epidemiology in the University of Georgia College of Public Health, said in an announcement.

Linder, however, called the prescribing of antibiotics for viral illnesses such as uncomplicated bronchitis,an "event that should never happen," reports MedPage Today.

In the JAMA study, 33 rural and semi-rural primary care practices in a Pennsylvania healthcare system were split into three groups. One with no intervention, one using printed materials and one with a computer-assisted tool. 

Eleven practices used the print method, in which triage nurses gave patients a brochure explaining the difference between bronchitis and pneumonia and displayed a poster showing that information in the exam room. In that group, prescribing of antibiotics fell by 11.7 percentage points to 68.3 percent.

Eleven practices also used the computer-assisted tool, which alerted nurses to give patients the brochure when "cough" was entered into their electronic records.  That prompted a decrease of 13.3 percentage points to 60.7 percent of patients getting antibiotics.

Meanwhile, the use of antibiotics grew slightly in the control group, from 72.5 percent to 74.3 percent.

Fears of drug resistance have fueled the push to reduce the number of antibiotics prescribed and EHRs have been shown to help in that effort. Yet doctors also have to deal with patient demand, which could become an even bigger factor as patient-satisfaction scores become part of Meaningful Use regulations.   

To learn more:
- read the JAMA abstract
- find the editorial
- check out the MedPage Today article
- here's the cough study
- read the announcement


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