Medical Provider Interventions

Physicians need to balance their obligations toward society with their obligations toward their individual patients (4). The public health concern of antibiotic resistance does not always exert a compelling impact on physicians' antibiotic prescribing. For this reason, guideline recommendations and educational programs alone are unlikely to achieve ideal prescribing unless physician interventions highlight the problem of antimicrobial resistance from the standpoint of how

TABLE 1 Tools to Improve Antibiotic Treatment

Method

Professional-directed Academic detailing Practice guidelines Practice profiling

Public/patient/family-directed Home mailings Posters, pamphlets Videotapes

Video kiosks, computer module Viral prescription pads, "cold kits" Media (television, newspaper, radio)

References

7, 39, 65-70, 88, 95, 112 3, 68, 69, 71-79, 88, 113, 114 68, 80-82, 113, 114

39, 68, 69, 83-85, 95, 113, 114 39, 55, 68, 69, 88, 95, 112-114 55, 86, 87 90, 112 88, 89

System-directed

Delayed prescriptions 43,91,92

Restrictive formularies 50, 93, 94

Telephone advice/access to primary care 51, 84

Decision-support tools 95

Increased diagnostic specificity 96-102

it affects their patients. Physicians must be reassured regarding the safety of withholding antibiotics for patients with certain conditions, and given tools to distinguish between bacterial and viral infections and facilitate effective patient and family communication regarding antimicrobial use (10). Some tools that are available for changing physician behavior include:

  1. Academic detailing: Education outreach using local "peer leader" experts to conduct one-on-one or small-group sessions with physicians is an effective approach (7,65-70).
  2. Practice guidelines: The U.S. Centers for Disease Control and Prevention (CDC) has recently completed a series of practice guidelines regarding appropriate antibiotic use for adult acute respiratory infection, including: bronchitis (71), exacerbations of chronic obstructive pulmonary disease (72), pharyngitis (73), sinusitis (74), and nonspecific upper respiratory tract infections (75), and publishes regular guideline updates for influenza (76). The Infectious Diseases Society of America (3) and the American Thoracic Society (77) published recommendations for the management of adult community-acquired pneumonia. The American Academy of Pediatrics published guidelines for the diagnosis and antibiotic treatment of pediatric acute otitis media, the most common outpatient diagnosis for which an antibiotic is prescribed for children (78,79), and pediatric sinusitis (79).
  3. Practice profiling: Information and feedback to physicians regarding their individual and practice group's prescribing patterns is another intervention that can be effective for certain outcomes (68,80-82).
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