Pilot study for appropriate anti-infective community therapy. Effect of a guideline-based strategy to optimize use of antibiotics.

摘要

OBJECTIVE: To determine whether a community-wide, multi-intervention educational strategy (CoMPLI model) could enhance adoption of clinical guidelines and improve the use of antibiotics. DESIGN: Before-after trial using baseline and study periods with a control group. SETTING: A small community in central Ontario. PARTICIPANTS: Health professionals, the general public, and the pharmaceutical industry. INTERVENTIONS: The educational strategy (CoMPLI), carried out during 6 winter months, consisted of continuing medical education sessions for health professionals and pharmaceutical representatives and a parallel public education campaign that included town hall meetings and pamphlets distributed by local pharmacists. The two main messages were: do not use antibiotics for viral respiratory infections, and use drugs recommended in the publication, Anti-infective Guidelines for Community-Acquired Infections. MAIN OUTCOME MEASURES: Total number of antibiotic claims and adjusted odds ratios (OR) were used to measure the likelihood of physicians prescribing first- or second-line agents compared with the previous year and compared with control physicians. RESULTS: Claims in the study community decreased by nearly 10% during the 6-month study period compared with the baseline period from the previous year. Study physicians were 29% less likely (OR-1 = 0.71, range 0.67 to 0.76) to prescribe second-line antibiotics during the study period than physicians in the rest of the province. CONCLUSIONS: Physicians participating in the pilot study were more likely to follow drug recommendations outlined in published guidelines.