Antibiotics and acute respiratory tract infections: a policy evaluation of the CDC’s Get Smart about Antibiotics campaign.

Abstract

Acute respiratory tract infections (ARTIs) account for >20% of all outpatient visits in adults. Many of these patients are prescribed antibiotics that are inappropriate based on clinical practice guidelines (CPGs). Over the last 15+ years the Center for Disease Control (CDC) has conducted the Get Smart about Antibiotics (GSA) campaign to reduce over-prescribing to patients with self-limiting ARTIs that are non-indicated for antibiotics. I analyzed the impact of three nationally-focused GSA campaign activities (i.e., publishing CPGs, a national media campaign, and re-publishing material for Spanish-speaking populations) and two state-level GSA campaign activities (i.e., state-level funding and state-level participation in the GSA Week) on antibiotic prescribing in adult patients with office-diagnosed, non-indicated ARTIs (i.e., acute bronchitis, acute pharyngitis, acute rhino-sinusitis, and the common cold or acute non-specific upper respiratory tract infections). The analyses used two primary datasets: (1) Medical Expenditure Panel Survey (MEPS), which is nationally representative, and (2) the MarketScan claims database, which includes patients enrolled in large employer-sponsored health insurance plans. The odds that any antibiotics were prescribed were reduced after the publication of CPGs (MEPS: OR=0.68, p-value=0.01) and after the national media campaign (MEPS: ORR=0.76, p-value=0.01), which was driven by lower antibiotic prescribing to patients diagnosed with the common cold or acute non-specific upper respiratory tract infections. I did not find evidence of code-shifting into antibiotic-indicated ARTIs (i.e., streptococcal pharyngitis and pneumonia) associated with these campaign events. I also found that the odds of antibiotics prescribing were reduced with each additional year of state-level funding (MEPS: ORR=0.96, p-value=0.03; MarketScan: ORR=0.97, p-value < 0.001), which was driven by lower prescribing to patients across all non-indicated ARTIs. In summary, I found that the multi-faceted approach of the GSA campaign lowered antibiotic prescribing to adult patients diagnosed with a non-indicated ARTI in an office-based setting through the publication of CPGs, a national media campaign targeting patients and clinicians, and state-level funding to develop local campaigns. However, the rates of antibiotic prescribing in the sub-group of patients with acute bronchitis remained high (50-60%). Future efforts to reduce antibiotic prescribing should include targeting patients diagnosed with acute bronchitis.