Patient Education Helps Prevent Overuse of Antibiotics for Cough, Study Finds
FRIDAY Jan. 18, 2013 -- Patient education in the form of brochures and posters helps reduce the overuse of antibiotics to treat bronchitis in teens and adults, according to a new study.
The overuse of antibiotics to treat bronchitis could worsen trends in antibiotic resistance, the researchers noted. They said computer prompts alerting nurses to the need for patient education on the difference between bronchitis and pneumonia also are effective in reducing reliance on antibiotics.
The study, led by Dr. Ralph Gonzales of the University of California, San Francisco, involved 33 primary care practices that are part of an integrated health care system in central Pennsylvania.
At 11 practices, printed materials -- including educational brochures and posters explaining the difference between bronchitis and pneumonia -- were routinely offered to patients suffering from a cough. In 11 more practices, patients received computer-assisted "decision support" intervention. In these cases, when nurses typed "cough" into an electronic health record, an alert prompted them to provide the patient with an educational brochure. The remaining practices served as control sites.
For the study, which was published online Jan. 14 in the journal JAMA Internal Medicine, the researchers compared the rate of antibiotic prescription for uncomplicated acute bronchitis before and after the printed and computer-assisted interventions.
Overall, there were more than 9,800 visits for uncomplicated acute bronchitis when the study began and less than 6,300 visits during the interventions. The study found the percentage of teens and adults given antibiotics dropped from 80 percent to about 68 percent at the sites with printed materials and from 74 percent to about 61 percent at practices with computer-assisted decision support.
The difference in effectiveness of the printed and computer-assisted decision support was not statistically significant, the researchers noted.
In contrast, the study revealed that the percentage of teens and adults with bronchitis who were prescribed antibiotics increased slightly -- from 73 percent to 74 percent -- at the control sites.
"We found that printed and computer-assisted approaches were equally effective at improving antibiotic treatment of uncomplicated acute bronchitis," the researchers said in a journal news release. "In aggregate, these findings support the wider dissemination and use of [these materials] to help reduce the overuse of antibiotics for acute bronchitis."
Dr. Jeffrey Linder, of Brigham and Women's Hospital and Harvard Medical School in Boston, also weighed in on the study.
"Despite the evidence, meta-analyses and performance measures, antibiotic prescribing for acute bronchitis in the United States remains at more than 70 percent," he said in the news release. "We should address patients' symptoms, but for antibiotics we need to tell our patients that this medicine is more likely to hurt [them] than to help [them]. Success is not reducing the antibiotic prescribing rate by 10 percent; success is reducing the antibiotic prescribing rate to 10 percent."
The overuse of antibiotics to treat acute respiratory tract infections is exacerbating antibiotic resistance, the researchers noted. They added that roughly 30 percent of doctor visits for colds and upper respiratory tract infections and as many as 80 percent of all visits for bronchitis are treated with antibiotics.
The U.S. Centers for Disease Control and Prevention provides more information on the overuse of antibiotics.
Posted: January 2013
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