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BMC Public Health
Published in: BMC Public Health 1/2019

Open Access 01-12-2019 | Antibiotic | Research article

Communication interventions to promote the public’s awareness of antibiotics: a systematic review

Authors: Valerie R. Burstein, Renee P. Trajano, Richard L. Kravitz, Robert A. Bell, Darshan Vora, Larissa S. May

Published in: BMC Public Health | Issue 1/2019

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Abstract

Background

Inappropriate antibiotic use is implicated in antibiotic resistance and resultant morbidity and mortality. Overuse is particularly prevalent for outpatient respiratory infections, and perceived patient expectations likely contribute. Thus, various educational programs have been implemented to educate the public.

Methods

We systematically identified public-directed interventions to promote antibiotic awareness in the United States. PubMed, Google Scholar, Embase, CINAHL, and Scopus were queried for articles published from January 1996 through January 2016. Two investigators independently assessed titles and abstracts of retrieved articles for subsequent full-text review. References of selected articles and three review articles were likewise screened for inclusion. Identified educational interventions were coded for target audience, content, distribution site, communication method, and major outcomes.

Results

Our search yielded 1,106 articles; 34 met inclusion criteria. Due to overlap in interventions studied, 29 distinct educational interventions were identified. Messages were primarily delivered in outpatient clinics (N = 24, 83%) and community sites (N = 12, 41%). The majority included clinician education. Antibiotic prescription rates were assessed for 22 interventions (76%). Patient knowledge, attitudes, and beliefs (KAB) were assessed for 10 interventions (34%). Similar rates of success between antibiotic prescription rates and patient KAB were reported (73 and 70%, respectively). Patient interventions that did not include clinician education were successful to increase KAB but were not shown to decrease antibiotic prescribing. Three interventions targeted reductions in Streptococcus pneumoniae resistance; none were successful.

Conclusions

Messaging programs varied in their designs, and many were multifaceted in their approach. These interventions can change patient perspectives regarding antibiotic use, though it is unclear if clinician education is also necessary to reduce antibiotic prescribing. Further investigations are needed to determine the relative influence of interventions focusing on patients and physicians and to determine whether these changes can influence rates of antibiotic resistance long-term.
Appendix
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Literature
1.
2.
Shapiro DJ, Hicks LA, Pavia AT, Hersh AL. Antibiotic prescribing for adults in ambulatory care in the USA, 2007-09. J Antimicrob Chemother. 2014;69(1):234–40.PubMedCrossRef
3.
Gonzales R, Malone DC, Maselli JH, Sande MA. Excessive antibiotic use for acute respiratory infections in the United States. Clin Infect Dis. 2001;33(6):757–62.PubMedCrossRef
4.
Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA. 1997;278(11):901–4.PubMedCrossRef
5.
Nyquist AC, Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for children with colds, upper respiratory tract infections, and bronchitis. JAMA. 1998;279(11):875–7.PubMedCrossRef
6.
Welschen I, Kuyvenhoven M, Hoes A, Verheij T. Antibiotics for acute respiratory tract symptoms: patients' expectations, GPs' management and patient satisfaction. Fam Pract. 2004;21(3):234–7.PubMedCrossRef
7.
Cockburn J, Pit S. Prescribing behaviour in clinical practice: patients' expectations and doctors' perceptions of patients' expectations--a questionnaire study. BMJ. 1997;315(7107):520–3.PubMedPubMedCentralCrossRef
8.
Macfarlane J, Holmes W, Macfarlane R, Britten N. Influence of patients' expectations on antibiotic management of acute lower respiratory tract illness in general practice: questionnaire study. BMJ. 1997;315(7117):1211–4.PubMedPubMedCentralCrossRef
9.
Al-Homaidan HT, Barrimah IE. Physicians' knowledge, expectations, and practice regarding antibiotic use in primary health care. Int J Health Sci (Qassim). 2018;12(3):18–24.
10.
Mangione-Smith R, McGlynn EA, Elliott MN, McDonald L, Franz CE, Kravitz RL. Parent expectations for antibiotics, physician-parent communication, and satisfaction. Arch Pediatr Adolesc Med. 2001;155(7):800–6.PubMedCrossRef
11.
Yong MK, Buising KL, Cheng AC, Thursky KA. Improved susceptibility of gram-negative bacteria in an intensive care unit following implementation of a computerized antibiotic decision support system. J Antimicrob Chemother. 2010;65(5):1062–9.PubMedCrossRef
12.
Fridkin SK, Srinivasan A. Implementing a strategy for monitoring inpatient antimicrobial use among hospitals in the United States. Clin Infect Dis. 2014;58(3):401–6.PubMedCrossRef
13.
May L, Gudger G, Armstrong P, Brooks G, Hinds P, Bhat R, Moran GJ, Schwartz L, Cosgrove SE, Klein EY, et al. Multisite exploration of clinical decision making for antibiotic use by emergency medicine providers using quantitative and qualitative methods. Infect Control Hosp Epidemiol. 2014;35(9):1114–25.PubMedPubMedCentralCrossRef
14.
15.
Weissman J, Besser RE. Promoting appropriate antibiotic use for pediatric patients: a social ecological framework. Semin Pediatr Infect Dis. 2004;15(1):41–51.PubMedCrossRef
16.
Finch RG, Metlay JP, Davey PG, Baker LJ, International Forum on Antibiotic Resistance c. Educational interventions to improve antibiotic use in the community: report from the international forum on antibiotic resistance (IFAR) colloquium, 2002. Lancet Infect Dis. 2004;4(1):44–53.PubMedCrossRef
17.
Huttner B, Goossens H, Verheij T, Harbarth S, Consortium C. Characteristics and outcomes of public campaigns aimed at improving the use of antibiotics in outpatients in high-income countries. Lancet Infect Dis. 2010;10(1):17–31.PubMedCrossRef
18.
SCea A. Reducing parental demand for antibiotics by promoting communication skills. Am J Health Educ. 2005;36(3):132–9.CrossRef
19.
SCea A. Community intervention model to reduce inappropriate antibiotic use. Am J Health Educ. 2010;41(1):20–8.CrossRef
20.
Ashe D, Patrick PA, Stempel MM, Shi Q, Brand DA. Educational posters to reduce antibiotic use. J Pediatr Health Care. 2006;20(3):192–7.PubMedCrossRef
21.
Bauchner H, Osganian S, Smith K, Triant R. Improving parent knowledge about antibiotics: a video intervention. Pediatrics. 2001;108(4):845–50.PubMedCrossRef
22.
Bell N. Antibiotic resistance: the Iowa experience. Am J Manag Care. 2002;8(11):988–94.PubMed
23.
Belongia EA, Knobloch MJ, Kieke BA, Davis JP, Janette C, Besser RE. Impact of statewide program to promote appropriate antimicrobial drug use. Emerg Infect Dis. 2005;11(6):912–20.PubMedPubMedCentralCrossRef
24.
Belongia EA, Sullivan BJ, Chyou PH, Madagame E, Reed KD, Schwartz B. A community intervention trial to promote judicious antibiotic use and reduce penicillin-resistant Streptococcus pneumoniae carriage in children. Pediatrics. 2001;108(3):575–83.PubMedCrossRef
25.
Croft DR, Knobloch MJ, Chyou PH, Ellen DV, Janette C, Davis JP, Besser RE, Belongia EA. Impact of a child care educational intervention on parent knowledge about appropriate antibiotic use. WMJ. 2007;106(2):78–84.PubMed
26.
Doyne EO, Alfaro MP, Siegel RM, Atherton HD, Schoettker PJ, Bernier J, Kotagal UR. A randomized controlled trial to change antibiotic prescribing patterns in a community. Arch Pediatr Adolesc Med. 2004;158(6):577–83.PubMedCrossRef
27.
Finkelstein JA, Davis RL, Dowell SF, Metlay JP, Soumerai SB, Rifas-Shiman SL, Higham M, Miller Z, Miroshnik I, Pedan A, et al. Reducing antibiotic use in children: a randomized trial in 12 practices. Pediatrics. 2001;108(1):1–7.PubMedCrossRef
28.
Finkelstein JA, Huang SS, Kleinman K, Rifas-Shiman SL, Stille CJ, Daniel J, Schiff N, Steingard R, Soumerai SB, Ross-Degnan D, et al. Impact of a 16-community trial to promote judicious antibiotic use in Massachusetts. Pediatrics. 2008;121(1):e15–23.PubMedCrossRef
29.
Gonzales R, Corbett KK, Leeman-Castillo BA, Glazner J, Erbacher K, Darr CA, Wong S, Maselli JH, Sauaia A, Kafadar K. The "minimizing antibiotic resistance in Colorado" project: impact of patient education in improving antibiotic use in private office practices. Health Serv Res. 2005;40(1):101–16.PubMedPubMedCentralCrossRef
30.
Gonzales R, Corbett KK, Wong S, Glazner JE, Deas A, Leeman-Castillo B, Maselli JH, Sebert-Kuhlmann A, Wigton RS, Flores E, et al. "Get smart Colorado": impact of a mass media campaign to improve community antibiotic use. Med Care. 2008;46(6):597–605.PubMedCrossRef
31.
Gonzales R, Sauaia A, Corbett KK, Maselli JH, Erbacher K, Leeman-Castillo BA, Darr CA, Houck PM. Antibiotic treatment of acute respiratory tract infections in the elderly: effect of a multidimensional educational intervention. J Am Geriatr Soc. 2004;52(1):39–45.PubMedCrossRef
32.
Gonzales R, Steiner JF, Lum A, Barrett PH Jr. Decreasing antibiotic use in ambulatory practice: impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults. JAMA. 1999;281(16):1512–9.PubMedCrossRef
33.
Greene JB, Dolder C, Wallis ML. The NC Tars Project: students leading the way to educate patients about proper use of antibiotics. J Am Pharm Assoc. 2003;51(4):539–43 531 p following 543.CrossRef
34.
Greene RA, Beckman H, Chamberlain J, Partridge G, Miller M, Burden D, Kerr J. Increasing adherence to a community-based guideline for acute sinusitis through education, physician profiling, and financial incentives. Am J Manag Care. 2004;10(10):670–8.PubMed
35.
Harris RH, MacKenzie TD, Leeman-Castillo B, Corbett KK, Batal HA, Maselli JH, Gonzales R. Optimizing antibiotic prescribing for acute respiratory tract infections in an urban urgent care clinic. J Gen Intern Med. 2003;18(5):326–34.PubMedPubMedCentralCrossRef
36.
Hennessy TW, Petersen KM, Bruden D, Parkinson AJ, Hurlburt D, Getty M, Schwartz B, Butler JC. Changes in antibiotic-prescribing practices and carriage of penicillin-resistant Streptococcus pneumoniae: a controlled intervention trial in rural Alaska. Clin Infect Dis. 2002;34(12):1543–50.PubMedCrossRef
37.
Hickman DE, Stebbins MR, Hanak JR, Guglielmo BJ. Pharmacy-based intervention to reduce antibiotic use for acute bronchitis. Ann Pharmacother. 2003;37(2):187–91.PubMedCrossRef
38.
Huang SS, Rifas-Shiman SL, Kleinman K, Kotch J, Schiff N, Stille CJ, Steingard R, Finkelstein JA. Parental knowledge about antibiotic use: results of a cluster-randomized, multicommunity intervention. Pediatrics. 2007;119(4):698–706.PubMedCrossRef
39.
Kiang KM, Kieke BA, Como-Sabetti K, Lynfield R, Besser RE, Belongia EA. Clinician knowledge and beliefs after statewide program to promote appropriate antimicrobial drug use. Emerg Infect Dis. 2005;11(6):904–11.PubMedPubMedCentralCrossRef
40.
Mainous AG 3rd, Diaz VA, Carnemolla M. A community intervention to decrease antibiotics used for self-medication among Latino adults. Ann Fam Med. 2009;7(6):520–6.PubMedPubMedCentralCrossRef
41.
Mainous AG 3rd, Hueston WJ, Love MM, Evans ME, Finger R. An evaluation of statewide strategies to reduce antibiotic overuse. Fam Med. 2000;32(1):22–9.PubMed
42.
Metlay JP, Camargo CA Jr, MacKenzie T, McCulloch C, Maselli J, Levin SK, Kersey A, Gonzales R, Investigators I. Cluster-randomized trial to improve antibiotic use for adults with acute respiratory infections treated in emergency departments. Ann Emerg Med. 2007;50(3):221–30.PubMedCrossRef
43.
Perz JF, Craig AS, Coffey CS, Jorgensen DM, Mitchel E, Hall S, Schaffner W, Griffin MR. Changes in antibiotic prescribing for children after a community-wide campaign. JAMA. 2002;287(23):3103–9.PubMedCrossRef
44.
Rubin MA, Bateman K, Alder S, Donnelly S, Stoddard GJ, Samore MH. A multifaceted intervention to improve antimicrobial prescribing for upper respiratory tract infections in a small rural community. Clin Infect Dis. 2005;40(4):546–53.PubMedCrossRef
45.
Samore MH, Bateman K, Alder SC, Hannah E, Donnelly S, Stoddard GJ, Haddadin B, Rubin MA, Williamson J, Stults B, et al. Clinical decision support and appropriateness of antimicrobial prescribing: a randomized trial. JAMA. 2005;294(18):2305–14.PubMedCrossRef
46.
Schnellinger M, Finkelstein M, Thygeson MV, Vander Velden H, Karpas A, Madhok M. Animated video vs pamphlet: comparing the success of educating parents about proper antibiotic use. Pediatrics. 2010;125(5):990–6.PubMedCrossRef
47.
Stille CJ, Rifas-Shiman SL, Kleinman K, Kotch JB, Finkelstein JA. Physician responses to a community-level trial promoting judicious antibiotic use. Ann Fam Med. 2008;6(3):206–12.PubMedPubMedCentralCrossRef
48.
Suffoletto B, Calabria J, Ross A, Callaway C, Yealy DM. A mobile phone text message program to measure oral antibiotic use and provide feedback on adherence to patients discharged from the emergency department. Acad Emerg Med. 2012;19(8):949–58.PubMedCrossRef
49.
Taylor JA, Kwan-Gett TS, EM MM Jr. Effectiveness of a parental educational intervention in reducing antibiotic use in children: a randomized controlled trial. Pediatr Infect Dis J. 2005;24(6):489–93.PubMedCrossRef
50.
Trepka MJ, Belongia EA, Chyou PH, Davis JP, Schwartz B. The effect of a community intervention trial on parental knowledge and awareness of antibiotic resistance and appropriate antibiotic use in children. Pediatrics. 2001;107(1):E6.PubMedCrossRef
51.
Wheeler JG, Fair M, Simpson PM, Rowlands LA, Aitken ME, Jacobs RF. Impact of a waiting room videotape message on parent attitudes toward pediatric antibiotic use. Pediatrics. 2001;108(3):591–6.PubMedCrossRef
52.
53.
Little P, Stuart B, Francis N, Douglas E, Tonkin-Crine S, Anthierens S, Cals JWL, Melbye H, Santer M, Moore M, et al. Antibiotic prescribing for acute respiratory tract infections 12 months after communication and CRP training: a randomized trial. Ann Fam Med. 2019;17(2):125–32.PubMedPubMedCentralCrossRef
Metadata
Title
Communication interventions to promote the public’s awareness of antibiotics: a systematic review
Authors
Valerie R. Burstein
Renee P. Trajano
Richard L. Kravitz
Robert A. Bell
Darshan Vora
Larissa S. May
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Antibiotic
Published in
BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-019-7258-3

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