Annals of Emergency Medicine
Volume 50, Issue 3 , Pages 221-230 , September 2007

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

Presented at the 29th annual meeting of the Society of General Internal Medicine, April 2006, Los Angeles, CA; and at the annual meeting of the Society for Academic Emergency Medicine, May 2006, San Francisco, CA.

  • Joshua P. Metlay, MD, PhD

      Affiliations

    • Center for Health Equity Research and Promotion, VA Medical Center, Philadelphia, PA
    • Division of General Internal Medicine and the Centers for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, PA
    • Corresponding Author InformationAddress for correspondence: Joshua P. Metlay, MD, PhD, University of Pennsylvania School of Medicine, 712 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104; 215-898-1484, fax 215-573-0198.
    • ,
  • Carlos A. Camargo Jr, MD, DrPH

      Affiliations

    • Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
    • ,
  • Thomas MacKenzie, MD, MSPH

      Affiliations

    • Denver Health Medical Center, Denver, CO
    • ,
  • Charles McCulloch, PhD

      Affiliations

    • Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
    • ,
  • Judith Maselli, MSPH

      Affiliations

    • Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA.
    • ,
  • Sara K. Levin, BA

      Affiliations

    • Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA.
    • ,
  • Ayanna Kersey, MPH

      Affiliations

    • Center for Health Equity Research and Promotion, VA Medical Center, Philadelphia, PA
    • ,
  • Ralph Gonzales, MD, MSPH

      Affiliations

    • Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
    • Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA.
    • ,
  • IMPAACT Investigators

      Affiliations

    • All members are listed in the Appendix.

Received 20 November 2006 ,Revised 9 March 2007 ,Accepted 16 March 2007.

References 

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  2. Cosgrove SE, Carmeli Y. The impact of antimicrobial resistance on health and economic outcomes. Clin Infect Dis. 2003;36:1433–1437
  3. Jernigan DB, Cetron MS, Breiman RF A strategy from the DRSP Working Group. Minimizing the impact of drug-resistant Streptococcus pneumoniae (DRSP). JAMA. 1996;275:206–209
  4. Avorn J, Solomon DH. Cultural and economic factors that (mis)shape antibiotic use: the nonpharmacologic basis of therapeutics. Ann Intern Med. 2000;133:128–135
  5. Gonzales R, Bartlett JG, Besser RE, et al. Principles of appropriate antibiotic use for treatment of acute respiratory tract infections in adults: background, specific aims, and methods. Ann Intern Med. 2001;134:479–486
  6. McCaig LF, Hughes JM. Trends in antimicrobial drug prescribing among office-based physicians in the United States. JAMA. 1995;273:214–219
  7. Finkelstein JA, Davis RL, Dowell SF, et al. Reducing antibiotic use in children: a randomized trial in 12 practices. Pediatrics. 2001;108:1–7
  8. Gonzales R, Steiner JF, Lum A, et al. Decreasing antibiotic use in ambulatory practice: impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults. JAMA. 1999;281:1512–1519
  9. Rubin MA, Bateman K, Alder S, et al. A multifaceted intervention to improve antimicrobial prescribing for upper respiratory tract infections in a small rural community. Clin Infect Dis. 2005;40:546–553
  10. McCaig LF, Besser RE, Hughes JM. Trends in antimicrobial prescribing rates for children and adolescents. JAMA. 2002;287:3096–3102
  11. Steinman MA, Gonzales R, Linder JA, et al. Changing use of antibiotics in community-based outpatient practice, 1991-1999. Ann Intern Med. 2003;138:525–533
  12. Roumie CL, Halasa NB, Grijalva CG, et al. Trends in antibiotic prescribing for adults in the United States—1995 to 2002. J Gen Intern Med. 2005;20:697–702
  13. Gonzales R, Camargo CA, MacKenzie T, et al. Antibiotic treatment of acute respiratory infections in acute care settings. Acad Emerg Med. 2006;13:288–294
  14. Metlay JP, Camargo CA, Bos K, et al. Assessing the suitability of intervention sites for quality improvement studies in emergency departments. Acad Emerg Med. 2005;12:667–670
  15. Gonzales R, Bartlett JG, Besser RE, et al. Principles of appropriate antibiotic use for treatment of uncomplicated acute bronchitis: background. Ann Intern Med. 2001;134:521–529
  16. Gonzales R, Bartlett JG, Besser RE, et al. Principles of appropriate antibiotic use for treatment of nonspecific upper respiratory tract infections in adults: background. Ann Intern Med. 2001;134:490–494
  17. Mullen PD, Hersey JC, Iverson DC. Health behavior models compared. Soc Sci Med. 1987;24:973–981
  18. Gonzales R, Malone DC, Maselli JH, et al. Excessive antibiotic use for acute respiratory infections in the United States. Clin Infect Dis. 2001;33:757–762
  19. Trandel-Korenchuk DM. Comparison of three visit-specific patient satisfaction instruments: reliability and validity measures and the effect of four methods of data collection on dimensions of patient satisfaction. J Ambul Care Manage. 1997;20:56–73
  20. Carey VC, Zeger SL, Diggle PJ. Modelling multivariate binary data with alternating logistic regressions. Biometrika. 1993;80:517–526
  21. Bishop YMM, Fienberg SE, Holland PW. Discrete Multivariate Analysis. Cambridge, MA: MIT Press; 1975;
  22. Ranji SR, Steinman MA, Shojania KG. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies. Rockville, MD: Agency for Healthcare Research and Quality; 2006;AHRQ Publication No. 04(06)-005104
  23. Belongia EA, Sullivan BJ, Chyou PH, et al. A community intervention trial to promote judicious antibiotic use and reduce penicillin-resistant Streptococcus pneumoniae carriage in children. Pediatrics. 2001;108:575–583
  24. Samore MH, Bateman K, Alder SC, et al. Clinical decision support and appropriateness of antimicrobial prescribing: a randomized trial. JAMA. 2005;294:2305–2314
  25. Metlay JP, Stafford RS, Singer DE. National trends in the use of antibiotics by primary care physicians for adult patients with cough. Arch Intern Med. 1998;158:1813–1818

 Supervising editor: Gregory J. Moran, MDAuthor contributions: JPM, CAC, TM, CM, and RG were responsible for study conception and design. JPM, JM, SKL, AK, and RG were responsible for acquisition of data and administrative, technical, or material support. JPM, CAC, TM, CM, JM, and RG conducted analysis and interpretation of data. JPM, CAC, CM, JM, and RG were responsible for drafting of the article and statistical analysis. JPM, CAC, TM, and RG obtaining funding. All authors provided critical revision of the manuscript. JPM and RG were responsible for study supervision. JPM and RG takes responsibility for the paper as a whole.Conflicts of interest: Dr. Metlay has served as a scientific consultant or received unrestricted educational funds from Aventis Pharmaceuticals and Roche Pharmaceuticals. Dr. Gonzales served as a consultant for Abbott Laboratories, Inc. to study C-reactive protein levels as a potential diagnostic test for outpatients with community-acquired pneumonia. Dr. Camargo has received financial support for participation in conferences, consulting, and medical research from the following industry sponsors with an interest in respiratory infections: Abbott, Aventis, Aventis Pasteur, GlaxoSmithKline, MedImmune, and Merck. None of the other authors have any conflicts of interest or financial disclosures.Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that may create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This study was funded by the Translating Research into Practice initiative, jointly sponsored by the Agency for Healthcare Research and Quality (1 R01 HS013915) and the Health Services Research and Development Service of the Department of Veterans Affairs (AVA-03-239). The funding agencies had no role in the design and conduct of the study; collection management, analysis, and interpretation of the data; or preparation, review, or approval of the article.Available online May 23, 2007.Reprints not available from the authors.

PII: S0196-0644(07)00383-6

doi: 10.1016/j.annemergmed.2007.03.022

Annals of Emergency Medicine
Volume 50, Issue 3 , Pages 221-230 , September 2007

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