Inappropriate Antibiotic Use Still High Despite Educational Efforts

The Center for Healthcare Research & Transformation (CHRT) today released an issue brief showing continued high rates of inappropriate antibiotic use, despite a 15-year national outreach campaign by the Centers for Disease Control and Prevention (CDC) to educate providers and consumers on the dangers of antibiotic overuse.

According to the CDC, antibiotic-resistant infections in the U.S. create $20 billion in excess healthcare costs and eight million additional hospital days. Antibiotics do not help or cure viral infections, such as bronchitis or the flu.

In Michigan, overall antibiotic prescribing for adult Blue Cross Blue Shield of Michigan (BCBSM) members decreased 9.3 percent from 2007 to 2009, but increased 4.5 percent for children during the same time period. The studies found significant differences in prescribing patterns between southeast Michigan and the rest of the state, particularly for children. Children in southeast Michigan were prescribed an average of .93 antibiotics per year, while children in outstate Michigan were prescribed an average of 1.0 per year.

"The continuing high rate of antibiotic use for viral infections in children and adultsparticularly outside of southeast Michiganis of great concern, as is the increase in the use of broad spectrum antibiotics in children," says Marianne Udow-Phillips, CHRT's director. "Using antibiotics when they are unnecessaryor treating simple infections with drugs that should be reserved for the most serious infectionsare practices that contribute to antibiotic resistance, making future infections harder to treat."

Highlights of the Antibiotic Prescribing and Use issue brief, an analysis of BCBSM data, include:

- BCBSM spent nearly $16.5 million for the top 10 antibiotics prescribed to adult members. Of these 10 most commonly prescribed drugs, five were listed by the National Committee for Quality Assurance (NCQA) as "antibiotics of concern" (broad spectrum drugs that should be reserved for infections that are difficult to treat). For BCBSM pediatric members, three of the 10 most commonly prescribed antibiotics were "antibiotics of concern."

- A geographic analysis of both adult and pediatric antibiotic prescribing patterns showed higher antibiotic use rates outside of southeast Michigan.

- Regions with higher overall antibiotic use rates for children also had higher percentages of antibiotics used for conditions with viral diagnoses.

- Geographic differences were more pronounced in the pediatric population, with the highest prescribing rates clustered in the Upper Peninsula, northern lower Michigan, and along the Ohio border.

"One factor that might explain this geographic difference is that there are fewer pediatricians in these largely rural areas, and relatively more children being seen by family practitioners," says Gary L. Freed, MD, MPH, chief of the Division of General Pediatrics at the University of Michigan and director of the Child Health Evaluation and Research (CHEAR) unit at C.S. Mott Children's Hospital. "The CDC's outreach efforts were focused on pediatricians, and in areas where there are more pediatricians, the antibiotic prescribing rate for pediatric patients is lower. This may indicate that the campaign did work as intended, and could be broadened to include other physicians."

The Antibiotic Prescribing and Use issue brief is the sixth in a series examining the price and patterns of healthcare in Michigan. While the report identifies important trends and geographic patterns, more research is needed to understand how physician and patient preferences influence the use of antibiotics in Michigan. The report also shows that messages from the CDC campaign may have been successful in raising awareness about appropriate antibiotic use among pediatricians, and points to the need for more targeted messaging to internists and family practitioners.

The Center for Healthcare Research & Transformation sponsors research and public information to promote evidence-based health care delivery, improve population health, and expand access to care. Housed at the University of Michigan, CHRT is a partnership between U-M and Blue Cross Blue Shield of Michigan to test the best ideas for improving the effectiveness and efficiency of the health care system.