A Continuing Medical Education Campaign to Improve Use of Antibiotics in Primary Care

Because inappropriate use of antibiotics is common, it is an important area for continuing medical education. At an annual review, we conducted a two-year campaign to achieve appropriate use. Our methods included two surveys, directed course content, programmatic evaluation, and a sample practice audit. Ninety percent of learners perceived inappropriate antibiotic use as a “very big” or “big” problem in the United States, but only 44% perceived this about their practice ( ). Top perceived barriers to appropriate antibiotic use were patient expectations, breaking old habits, and fear that patients would go elsewhere. Top strategies to overcome these barriers were patient educational materials, having guidelines accessible, and developing practice policies. In a hypothetical patient with acute bronchitis, 98% would likely prescribe an antibiotic in certain clinical scenarios even though The Centers for Disease Control and Prevention does not recommend empiric antibiotic treatment. The most common scenarios leading to likely antibiotic prescription were symptoms over 15 days (84%), age over 80 years (70%), and fever (48%). Practitioners are under multiple pressures to prescribe antibiotics even in situations where antibiotics are not recommended (such as acute bronchitis). To achieve complex practice changes such as avoiding inappropriate antibiotic use, no one strategy predominated. 1. Introduction In contemporary continuing medical education, we recognize that education does not end in the classroom and that medical meetings alone are not likely to be effective for changing complex behaviors [1]. Multifaceted interventions are more likely to result from an educational campaign rather than from a single educational session [2, 3]. In addition, Accreditation Council for Continuing Medical Education (ACCME) accreditation criteria for compliance require a continuing medical education (CME) provider “to integrate CME into the process for improving professional practice” (accreditation criterion 16), “identify factors outside the provider’s control that impact outcomes” (accreditation criterion 18), and “implement educational strategies to remove, overcome, or address barriers to physician change” (accreditation criterion 19) [4]. One practice area in the United States where improvement is needed is inappropriate use of antibiotics. Up to 48% of patients with rhinopharyngitis and up to 73% of patients with acute bronchitis are prescribed antibiotics even though these infections are generally not responsive to antibiotic therapy [5–8]. The Centers for Disease