Table 1AQI strategies and outcomes for antibiotic treatment studies

Author Setting and Target Patient Population Disease Target Study Design (Effective sample size) Study Period (Duration/months) QI Strategies Employed Outcomes Reported
Pt Ed Delayed Clin Ed Clin Remind Audit & Fdbck Org Change Pt Incentives Clin Incentives
Finkelstein J 1 United States Children ARI RCT (—) 1997-1998 (12) Antibiotics prescribed per person-year
12 practices affiliated with 2 managed care organizations
Angunawela I 2 Sri Lanka All patients Not specified RCT (1048) 1988 (2) % of pt visits resulting in ABX prescription
General practitioners at rural primary care clinics
Angunawela I 3 Sri Lanka All patients Not specified RCT (1348) 1988 (2) % of pt visits resulting in ABX prescription
General practitioners at rural primary care clinics
Arroll, B 4 New Zealand All patients ARI (Common cold) RCT (129) — (10 days) % of pt visits resulting in ABX prescription
General practitioners Clinical outcomes
Pt/Clin Satisfaction
Belongia, E 5 United States Children ARI (Common cold, Acute sinusitis, Pharyngitis, Bronchitis, Otitis media) CBA (370) 1997 (4) % of pt visits resulting in ABX prescription
Multiple counties in Northern Wisconsin Antimicrobial resistance
Bexell, A 6 Zambia All patients Not specified QRCT (1113) 1991 (5) % of pt visits resulting in ABX prescription
General Practices
Christakis, D 7 United States Children ARI (Otitis media) RCT (—) — (8) Change in % of pt visits resulting in ABX prescription
Academic pediatric primary care clinic Duration of ABX therapy
Dowell, J 8 UK Adults ARI (Cough) RCT (194) 1997-1998 (—) % of pt visits resulting in ABX prescription
General practitioners in Scotland Clinical outcome
Health services utilization
Pt/Clin Satisfaction
Flottorp, S 9 Norway All patients ARI (Sore throat) RCT (1739) 2000-2001 (9) % of pt visits resulting in ABX prescription
142 General practices Health services utilization
Foxman, B 10 United States All patients Not specified RCT (—) 1975 (12) ABX prescriptions per person-year
6 cities: Dayton, OH; Seattle, WA; Fitchburg, MA; Franklin County, MA; Charleston, SC; Georgetown County, SC
Gonzales, R 11 United States Adults ARI (Acute bronchitis) CBA (1213) 1997-1998 (4) % of pt visits resulting in ABX prescription
4 HMO primary care practices Health services utilization
Gonzales, R 12 United States Adults ARI (Acute bronchitis) CBA (1197) 1997-1998 (4) % of pt visits resulting in ABX prescription
4 HMO primary care practices Health services utilization
Gonzales-Ochoa, E 13 Cuba Children ARI QRCT (122) 1991 (12) % of pt visits resulting in ABX prescription
General practitioners in 4 areas of Havana
Gonzales-Ochoa, E 14 Cuba Children ARI QRCT (100) 1991 (12) % of pt visits resulting in ABX prescription
General practitioners in 4 areas of Havana
Gonzales-Ochoa, E 15 Cuba Children ARI QRCT (100) 1991 (12) % of pt visits resulting in ABX prescription
General practitioners in 4 areas of Havana
Gutierrez, G 16 Mexico All patients Diarrhea CBA (152) — (18) % of pt visits resulting in ABX prescription
General practitioners at health care clinics of the Mexican Social Security Institute
Hennessy, T 17 United States All patients ARI CBA (2163) 1998-1999 (6) % of pt visits resulting in ABX prescription Antimicrobial resistance
13 rural Alaskan villages
Hickman, D 18 United States All patients ARI (Acute bronchitis) CBA (1943) 1998 (4) % of pt visits resulting in ABX prescription
Suburban community-based physician group Health services utilization
Little, P 19 UK Children ARI (Otitis media) RCT (285) — (1 week) % of pt visits resulting in ABX prescription
General practices in southwest England Clinical outcome
Pt/Clin Satisfaction
Macfarlane, J 20 UK Adults ARI (Acute bronchitis) RCT (205) 1999-2000 (11) % of pt visits resulting in ABX prescription
General practices Health service utilization
Mainous, A 21 United States Children ARI RCT (2564) 1997 (1) % of pt visits resulting in ABX prescription
8 Medicaid administrative regions in Kentucky
Mainous, A 22 United States Children ARI RCT (2740) 1997 (1) % of pt visits resulting in ABX prescription
8 Medicaid administrative regions in Kentucky
Mainous, A 23 United States Children ARI RCT (2297) 1997 (1) % of pt visits resulting in ABX prescription
8 Medicaid administrative regions in Kentucky
McConnell, T 24 United States All patients ARI RCT (—) 1997-1998 (?) ABX prescriptions per provider
New Mexico Medicaid program Compliance to clinical guideline
McIsaac, W 25 Canada All patients ARI (Sore throat) RCT (396) 1996 (—) % of pt visits resulting in ABX prescription
Family physicians in Ontario
McIsaac, W 26 Canada All patients ARI (Sore throat) RCT (99) 1998 (—) % of pt visits resulting in ABX prescription
Family physicians in Ontario
Melander, E 27 Sweden All patients ARI CBA (857) 1995 (—) % of pt visits resulting in ABX prescription
General practitioners
Meyer, J 28 South Africa All patients ARI Diarrhea RCT (383) 1997 (6) % of pt visits resulting in ABX prescription
Nurses in primary health clinics
O'Connell, D 29 Australia All patients Not specified RCT (—) 1995 (7) ABX prescriptions per 100 patient visits
General practitioners in rural area
Perz, J 30 United States Children Not specified CBA (—) 1997-1998 (12) ABX prescriptions per person- year
4 counties in Tennessee
Santoso, B 31 Indonesia Children Diarrhea RCT (1638) % of pt visits resulting in ABX prescription
General practitioners in Yogyakarta and Java provinces
Santoso, B 32 Indonesia Children Diarrhea RCT (1638) % of pt visits resulting in ABX prescription
General practitioners in Yogyakarta and Java provinces
Zwar, N 33 Australia All patients ARI RCT (—) % of pt visits resulting in ABX prescription
General practitioner trainees in New South Wales
McNulty, C 34 UK All patients Not specified CBA (—) 1997 (7 weeks) Total ABX prescriptions
General practices in Gloucestershire Cost
Welschen, I 35 The Netherlands All patients ARI QRCT (1074) 2000-2001 (9) % of pt visits resulting in ABX prescription
General practitioners in Utrecht Pt/Clin Satisfaction
Molstad, S 36 Sweden All patients ARI (Rhinitis, Pharyngitis, Acute bronchitis) CBA (372) 1985 (2) % of pt visits resulting in ABX prescription
General practitioners at community health centers
Cates, C 37 UK Children ARI (Otitis media) CBA (—) 1997-1998 (12) ABX prescriptions per clinic
General practitioners in outpatient clinics in Hertfordshire
Pshetizky, Y 38 Israel Children ARI (Otitis media) RCT (81) 1998-1999 % of pt visits resulting in ABX prescription
General practitioners
Smabrekke, L 39 Norway Children ARI (Otitis media) CBA (329) 1998-1999 (4) % of pt visits resulting in ABX prescription
Physicians and nurses at urgent care clinic
Wilson, E 40 Australia Children ARI RCT (—) 1998 (4) Prescriptions per 100 patient visits
General practitioners in Canberra
Coenen, S 41 Belgium Adults ARI RCT (238) 2001 (1) % of pt visits resulting in ABX prescription
General practitioners Cost
Health service utilization
Clinical outcomes

Abbreviations: ARI = acute respiratory infection; UTI = urinary tract infection; ABX = antibiotics, CBA = controlled before-after study; RCT = randomized controlled trial; QRCT = quasi randomized controlled trial; Pt Ed = patient education; Delayed = provision of delayed prescriptions; Clin Remind = Clinician Reminder; Clin Ed = clinician education; Audit & Fdbck = clinician audit and feedback; Org Change = Organizational change; Pt Incentives = patient-directed financial or regulatory incentives; Clin Incentives = clinician-directed financial or regulatory incentives

From: 3, Results

Cover of Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 4: Antibiotic Prescribing Behavior)
Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 4: Antibiotic Prescribing Behavior).
Technical Reviews, No. 9.4.
Ranji SR, Steinman MA, Shojania KG, et al.

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