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Impact of a 16-community trial to promote judicious antibiotic use in Massachusetts . OBJECTIVES Reducing unnecessary antibiotic use , particularly among children , continues to be a public health priority . Previous intervention studies have been limited by size or design and have shown mixed results . The objective of this study was to determine the impact of a multifaceted , community-wide intervention on overall antibiotic use for young children and on use of broad-spectrum agents . In addition , we sought to compare the intervention 's impact on commercially and Medicaid-insured children . METHODS We conducted a controlled , community-level , cluster-randomized trial in 16 nonoverlapping Massachusetts communities , studied from 1998 to 2003 . During 3 years , we implemented a physician behavior-change strategy that included guideline dissemination , small-group education , frequent updates and educational materials , and prescribing feedback . Parents received educational materials by mail and in primary care practices , pharmacies , and child care settings . Using health-plan data , we measured changes in antibiotics dispensed per person-year of observation among children who were aged 3 to < 72 months , resided in study communities , and were insured by a participating commercial health plan or Medicaid . RESULTS The data include 223,135 person-years of observation . Antibiotic-use rates at baseline were 2.8 , 1.7 , and 1.4 antibiotics per person-year among those aged 3 to < 24 , 24 to < 48 , and 48 to < 72 months , respectively . We observed a substantial downward trend in antibiotic prescribing , even in the absence of intervention . The intervention had no additional effect among children aged 3 to < 24 months but was responsible for a 4.2 % decrease among those aged 24 to < 48 months and a 6.7 % decrease among those aged 48 to < 72 months . The intervention effect was greater among Medicaid-insured children and for broad-spectrum agents . CONCLUSIONS A sustained , multifaceted , community-level intervention was only modestly successful at decreasing overall antibiotic use beyond substantial secular trends . The more robust impact among Medicaid-insured children and for specific medication classes provides an argument for specific targeting of resources for patient and physician behavior change .
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Intervention_Educational
multifaceted , community-wide intervention on overall antibiotic use
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Intervention_Educational
physician behavior-change strategy that included guideline dissemination , small-group education , frequent updates and educational materials , and prescribing feedback
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Intervention_Educational
educational materials by mail and in primary care practices , pharmacies , and child care settings
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Outcome_Mental
Antibiotic-use rates
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Outcome_Mental
antibiotic prescribing
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Outcome_Mental
overall antibiotic use
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Participant_Sample-size
16
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Participant_Age
children who were aged 3 to < 72 months
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Participant_Sample-size
223,135