BACKGROUND: Judicious use of antibiotics is essential to combatting drug-resistant infections. At least 30% of antibiotics prescribed in the outpatient setting are unnecessary. Illinois community pharmacies dispensed 853 antibiotic prescriptions per 1,000 people in 2013-2014 which is slightly higher than the national average. The Illinois Department of Public Health (IDPH) launched the statewide Precious Drugs & Scary Bugs Campaign in March 2015 to promote the appropriate use of antibiotics in the outpatient setting. Participating facilities displayed poster-sized letters to patients, personalized with provider photos and names, which stated providers’ commitment to prescribe antibiotics appropriately for acute respiratory infections. IDPH assessed the commitment poster’s impact on antibiotic prescribing and provider-patient interactions.
METHODS: IDPH encouraged participating facilities to track changes in the avoidance of antibiotic treatment in adults with bronchitis and the appropriate treatment for children with an upper respiratory infection (URI) for one year before and after poster implementation. These two quality measures are part of the Healthcare Effectiveness Data and Information Set (HEDIS), a nationally standardized tool used by health plans to measure performance on important dimensions of care and service. Chi-square tests were performed to determine if there was an association between the use of the poster and appropriate antibiotic prescribing after campaign implementation (alpha=0.05). IDPH also administered an online provider survey to determine how the posters impacted provider-patient interactions.
RESULTS: IDPH received summary antibiotic prescribing data from a medical group comprised of 19 practices. During poster implementation, the percent of adults with acute bronchitis who were not prescribed an antibiotic increased by three percent (p= 0.61) and appropriate treatment for children with URI increased by 24% (p = 0.0002) compared to baseline. Sixty-four providers completed the post-campaign survey. Most survey (64%) respondents noticed the posters displayed in their facility. Of these, 66% reported that the poster increased conversations about appropriate antibiotic use with patients and 43% reported that the poster reminded them to prescribe antibiotics only when needed.
CONCLUSIONS: Displaying a personalized commitment poster is a low cost quality improvement intervention with potential to increase appropriate antibiotic prescribing for acute respiratory infections. Commitment posters can also promote provider-patient conversations about appropriate antibiotic use.