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Reducing the volume of antibiotic prescriptions: a peer group intervention among physicians serving a community with special ethnic characteristics.

BACKGROUND
Antibiotics are a front-line weapon against many infectious diseases. However, antibiotic overuse is the key driver of drug resistance. Previously published studies have suggested benefits of using peer-to-peer education, working with group leaders to build trust and maintain confidentiality within a quality initiative. We hypothesized that working with physicians as a peer group might be beneficial in influencing antibiotic prescribing patterns.


OBJECTIVE
To describe and evaluate a peer group model for an intervention to reduce the volume of antibiotic prescriptions among physicians with above average prescribing rates serving an Arab community in northern Israel.


METHODS
Primary care physicians in a defined geographic area who served Arab communities and had high antibiotic prescribing rates--defined as above average number of antibiotic prescriptions per office visit compared with regional and organizational averages--were recruited for the intervention. All other physicians from the same region served as a comparison group. The intervention was administered during 2007 and was completed in early 2008. Four structured meetings scheduled 2 months apart, in which the group explored the issues related to antibiotic overuse, included the following topics: adherence to clinical guidelines; the special position physicians serving Arab communities hold and the influence it has on their practices; pressure due to consumer demands; and suggestions for possible strategies to face ethnic sensitivity, mainly because of the special ties the physicians have with their communities. T-tests for independent samples were used to perform between-group comparisons for each quarter and year of observation from 2006 through 2010, and t-tests for paired samples were used to compare pre-intervention with post-intervention antibiotic prescribing rates.


RESULTS
In the 2006 pre-intervention period, the antibiotic prescribing rates were 0.17 for the peer group (n = 11 physicians) and 0.15 for the comparison group (n = 72 physicians, P = 0.279). In 2008 following the intervention, rates were 0.12 and 0.14, respectively (P = 0.396). In the paired t-test analysis, rates declined significantly from 2006 to 2008 in the intervention group (P < 0.001) but not in the comparison group (P = 0.138). Antibiotic prescribing rates remained similar in 2009 and 2010.


CONCLUSION
In the context of a community with special ethnic and cultural characteristics, an intervention relying on peer group techniques was associated with a modest reduction in the volume of antibiotic prescriptions.