“Antibiotic Stewardship” Program Helps Pediatricians Cut Off-Guideline Antibiotic Use

This needs to spread across the medical profession and across the nation.

A program of education and feedback for pediatricians cut inappropriate antibiotic use by about half, a researcher reported here.

In a cluster-randomized trial, the off-guideline use of broad-spectrum antibiotics for acute respiratory infections fell 48% in nine practices that got the intervention, according to Jeffrey Gerber, MD, of the Children’s Hospital of Philadelphia.

In contrast, the use of broad-spectrum drugs in nine control practices fell by 18%, Gerber told reporters at the IDWeek meeting here.

While so-called antibiotic stewardship programs have been successful in hospitals, Gerber said, most antibiotics are prescribed in an outpatient setting, especially for children.

“It made sense to see if we could extend some of these principles to the outpatient setting,” Gerber said.

The Children’s Hospital of Philadelphia, he noted, is associated with 29 pediatric practices that share a common electronic health records system. He and colleagues recruited 18 of them, including 174 clinicians, to take part in the trial.

Practices in the intervention arm got an education session with Gerber or a colleague to discuss guidelines for three diseases – sinusitis, group A streptococcal pharyngitis, and pneumonia – that are best treated, according to guidelines, with narrow-spectrum drugs.

Preventing Unintended Pregnancies and Abortions Through No Cost Contraception

Research evidence confirms beneficial effects of Obamacare’s contraception mandate.

Here’s the abstract of the article from Obstetrics and Gynecology, along with news and commentary from Think Progress Health:

A new study focusing on low-income women in St. Louis, MO concludes that expanding access to free contraception — just as the health care reform law does through its provision to provide birth control without a co-pay — leads to significantly lower rates of unintended teen pregnancy and abortion. Researchers found that when women weren’t prohibited by cost, they chose more effective, long-lasting forms of birth controland experienced much fewer unintended pregnancies as a result.

Researchers from the Washington University School of Medicine in St. Louis worked in partnership with the local Planned Parenthood affiliate to track over 9,200 low-income women in the St. Louis area, some of whom lacked insurance coverage, during a four-year Contraceptive CHOICE study. The CHOICE project simulated Obamacare’s birth control provision by allowing teens and women to select from the full range of FDA-approved contraceptive options and receive their preferred method at no cost. They found that birth rates among the teens who received free birth control in the CHOICE project were less than a fifth of the national teen birth rate — just 6.3 births per 1,000 teens, compared to 34.3 per 1,000 teens nationwide in 2010 — and abortion rates were less than half of both the regional and national rates.

Undergraduate Public Health Education Expands

Some good news from the excellent Public Health Newswire:

At Worcester Polytechnic Institute in Massachusetts, all first-year students participate in a “great problems” seminar focusing on issues such as food sustainability, the world’s water supply or chronic disease. The early public health exposure means a number of those students end up doing public health work in their junior and senior years.

At Kapi’olani Community College in Hawaii, students choose from the service learning “pathways” of health, the environment and elder care as part of their general education curriculum. A recent service project matched Native Hawaiian students with native elders to work on health literacy.

“Their curriculum is just shot through with public health,” Susan Albertine, PhD, vice president at the Association of American Colleges and Universities, told The Nation’s Health. “It’s a beautiful thing.”