Minimizing Antibiotic Resistance in Colorado (MARC)

一个基础广泛的利益相关者联盟通过制定并向全州2600名初级保健医生传播临床实践指南和实践概况，合作减少科罗拉多州抗生素的过度使用。在大规模减少不必要的抗生素使用的努力中，是否、在多大程度上以及采用何种类型的公共和患者教育尚不清楚。科罗拉多州最小化抗生素耐药性(MARC)项目旨在评估两种常见的公共和患者教育机制在临床医生处方行为中的独立和综合边际影响：1)家庭和办公室材料，2)大众媒体(电视、广播、新闻纸、网站)。以下具体目标将审查与每个干预战略相关的护理过程和结果。该项目的结果将为州和联邦政府改善非卧床抗生素处方做法的努力提供信息。具体目标IA：利用(1)家庭和办公室材料以及(2)大众媒体制定和实施社区教育干预措施。具体目标IB：使用来自医生实践的商业MCO和医疗补助管理数据，测量和评估儿童咽炎和成人支气管炎的抗生素处方率变化。具体目标IIA：在干预社区内外进行家庭调查，以衡量每项教育战略对公众知识、态度、行为和自我效能的影响。具体目标IIB：进行临床医生判断分析，以衡量每种教育策略对临床医生决策的影响，以及与咽炎和支气管炎护理事件相关的授权。具体目的IIIA：对患者和父母进行调查，以衡量减少抗生素使用对咽炎儿童和成人支气管炎患者的病程和护理满意度的影响。具体目的IIIB：利用科罗拉多州公共卫生和环境部(CDPHE)的主动监测数据，比较干预社区内外侵袭性青霉素耐药肺炎链球菌感染的发生率。具体目标三：对不同级别的社区教育进行净成本分析。

A broad-based coalition of stakeholders has collaborated to reduce excess antibiotic use in Colorado by developing and disseminating clinical practice guidelines and practice profiles to 2600 primary care physicians throughout the state. Whether, how much and what type of public and patient education to employ on large-scale efforts to decrease unnecessary antibiotic use is not known. The Minimizing Antibiotic Resistance in Colorado (MARC) Project is designed to evaluate the independent and combined marginal impact of two common mechanisms of public and patient education in clinician prescribing behavior: 1) household and office-based materials, and 2) mass media (television, radio, newsprint, web site). The following specific aims will examine the processes and outcomes of care related to each intervention strategy. Results from this project will inform state and federal efforts to improve ambulatory antibiotic prescribing practices. Specific Aim IA: Develop and implement community educational interventions using (1) household and office-based materials, and (2) mass media. Specific Aim IB: Measure and assess changes in antibiotic prescription rates for pharyngitis in children, and bronchitis in adults, using commercial MCO and Medicaid administrative data from physician practices. Specific Aim IIA: Conduct household surveys in and outside the intervention communities to measure the impact of each education strategy on public knowledge, attitudes, behavior and self- efficacy. Specific Aim IIB: Conduct a clinician judgment analysis to measure the impact of each education strategy on clinician decision making and empowerment relating to episodes of care for pharyngitis and bronchitis. Specific Aim IIIA: Conduct a survey of patients and parents to measure the impact of decreased antibiotic use on duration of illness and satisfaction with care, for children with pharyngitis and adults with bronchitis. Specific Aim IIIB: Using active surveillance data from the Colorado Department of Public Health and Environment (CDPHE), compare the incidence of invasive penicillin-resistant S. pneumoniae infections in and outside the intervention communities. Specific Aim IIIC: Conduct a net-cost analysis of the different levels of community education.