Effects of Clinical Pathways for Common Outpatient Infections on Antibiotic Prescribing

• Published in: The American journal of medicine Vol. 126; no. 4; pp. 327 - 335.e12
• Main Authors: Jenkins, Timothy C., MD, Irwin, Amy, DNP, RN, Coombs, Letoynia, EdD, DeAlleaume, Lauren, MD, Ross, Stephen E., MD, Rozwadowski, Jeanne, MD, MPH, Webster, Brian, MD, Dickinson, L. Miriam, PhD, Sabel, Allison L., MD, PhD, MPH, MacKenzie, Thomas D., MD, MSPH, West, David R., PhD, Price, Connie S., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2013; Elsevier Sequoia S.A
• Subjects: Acute respiratory infection; Ambulatory Care; Anti-Bacterial Agents - therapeutic use; Antibiotic prescribing; Antibiotics; Antimicrobial stewardship; Clinical pathways; Critical Pathways; Decision Support Techniques; Drug Utilization - trends; Female; Guidelines; Humans; Inappropriate Prescribing - prevention & control; Infections; Internal Medicine; Male; Practice Guidelines as Topic; Practice Patterns, Physicians; Primary care; Respiratory diseases; Respiratory Tract Infections - drug therapy; Side effects; Studies; Clinical pathways; Acute respiratory infection; Antimicrobial stewardship; Primary care; Antibiotic prescribing; Guidelines
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/j.amjmed.2012.10.027

Abstract Background Antibiotic overuse in the primary care setting is common. Our objective was to evaluate the effect of a clinical pathway-based intervention on antibiotic use. Methods Eight primary care clinics were randomized to receive clinical pathways for upper respiratory infection, acute bronchitis, acute rhinosinusitis, pharyngitis, acute otitis media, urinary tract infection, skin infections, and pneumonia and patient education materials (study group) versus no intervention (control group). Generalized linear mixed effects models were used to assess trends in antibiotic prescriptions for non-pneumonia acute respiratory infections and broad-spectrum antibiotic use for all 8 conditions during a 2-year baseline and 1-year intervention period. Results In the study group, antibiotic prescriptions for non-pneumonia acute respiratory infections decreased from 42.7% of cases at baseline to 37.9% during the intervention period (11.2% relative reduction) ( P < .0001) and from 39.8% to 38.7%, respectively, in the control group (2.8% relative reduction) ( P =. 25). Overall use of broad-spectrum antibiotics in the study group decreased from 26.4% to 22.6% of cases, respectively (14.4% relative reduction) ( P < .0001) and from 20.0% to 19.4%, respectively, in the control group (3.0% relative reduction) ( P =. 35). There were significant differences in the trends of prescriptions for acute respiratory infections ( P < .0001) and broad-spectrum antibiotic use ( P =. 001) between the study and control groups during the intervention period, with greater declines in the study group. Conclusions This intervention was associated with declining antibiotic prescriptions for non-pneumonia acute respiratory infections and use of broad-spectrum antibiotics over the first year. Evaluation of the impact over a longer study period is warranted.