The impact of educational interventions on antibiotic prescribing for acute upper respiratory tract infections in the ambulatory care setting: A quasi-experimental study

Objective: To identify the proportion of viral acute upper respiratory tract infections (AURTI) inappropriately treated with antibiotics before and after the implementation of a multimodal outpatient antibiotic stewardship initiative in a real-world setting. Design: Pre-post, quasi-experimental study. Patients: Adult patients with a diagnosis of either acute bronchitis, influenza, unspecified viral infection, or unspecified AURTI who visited internal medicine (IM) or family medicine (FM) ambulatory care clinics at an urban, academic health system in 2016 and 2017. Interventions: Provider education including the dissemination of an institutional guideline and algorithm for the treatment of AURTI occurred in FM and IM clinics. In the FM clinics, a roundtable discussion with clinicians promoting safe and appropriate antibiotic prescribing was conducted, and patient-facing educational posters were placed in exam rooms and clinic waiting areas describing the FM teams' commitment to using antibiotics only when necessary. Results: A total of 2817 patient encounters met study inclusion criteria. In total, inappropriate antibiotic prescribing had a relative decrease of 24% after implementation of the interventions (17.2% [235/1362] preintervention vs 13.1% [191/1455] postintervention; P =.02). During the preintervention period, 25.4% (143/563) of the encounters in the IM clinics were associated with inappropriate antibiotic prescribing compared with 19% (108/568) in the postintervention period (P <.01). Relative to the IM clinics, the FM clinics had a lower proportion of encounters associated with inappropriate antibiotic prescribing at baseline. In FM clinics, 11.5% (92/799) of encounters were associated with inappropriate antibiotic prescribing during the preintervention period compared with 9.4% (83/887) during the postintervention period (P =.15). Conclusions: Simple educational interventions may decrease inappropriate antibiotic prescribing for AURTIs in outpatient settings. In addition, the incremental benefit of patient-facing education may be limited outside of randomized studies or in settings with low baseline antibiotic prescribing rates for AURTIs. Therefore, additional studies outside of randomized trials are needed.