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Am Fam Physician. 2000;61(6):1807-1808

Study Shows Interventions Failed to Reduce Antibiotic Prescriptions

(27th Annual Meeting of the North American Primary Care Research Group) According to a randomized controlled trial, the interventions of practice profiling feedback and patient education had little impact on promoting appropriate prescribing of antibiotics for pediatric upper respiratory infections (URIs). The study included 216 primary care physicians managing pediatric respiratory infections in Kentucky and 124,092 episodes of pediatric URIs. The researchers assessed the antibiotic prescribing of the physicians during a 17-month period, with the intervention occurring in the eleventh month. Physicians were randomized into four groups that received: (1) performance feedback only, (2) patient education materials only, (3) feedback and patient education materials or (4) no intervention. All groups had an increase in the proportion of URIs treated with antibiotics between pre- and postintervention. Antibiotic prescriptions did increase at a significantly slower rate in the group receiving patient education and in the group receiving the patient education and feedback than in the control group. The authors caution that a continued increase in the number of antibiotic prescriptions for viral respiratory infections poses a significant health threat because resistance to these antibiotics will likely increase as well.—arch g. mainous iii, ph.d., et al., Medical University of South Carolina, Charleston, South Carolina.

Health Education Promotes Lifestyle Changes in Obese Women

(North American Primary Care Research Group) In a randomized controlled trial of obese black women, a health education intervention was shown to promote lifestyle changes such as a significant increase of their participation in weekly physical exercise sessions, an increase in their daily intake of fiber and a decrease in their daily intake of fat. The trial included 23 obese (body mass index [BMI] greater than 30) black women with no physical limitations that would prevent moderate aerobic exercise. Participants in the intervention group attended five culturally sensitive, health education classes that promoted healthy lifestyles. Participants in the control group received a packet of information on healthy diet and exercise. Over the 10-week period, the women in the intervention group had a statistically significant increase in daily fiber intake (14.7 to 21.3 g), and a decrease in daily fat intake (51.3 to 39.8 percent). The intervention group also had an increase in physical exercise from 1.8 to 4.4 sessions per week. The control group showed no significant change in any of these lifestyle habits, and neither group had a significant change in their BMI. The researchers believe that a study conducted over a longer period of time may show an effect of this intervention on the BMI.—sherri lewis-stevenson, m.d., et al., Medical University of South Carolina, Charleston, South Carolina.

Sex Education Program Encourages Abstinence Among Teenagers

(North American Primary Care Research Group) Results of a study conducted in five high schools showed that an abstinence-based sex education program delayed the onset of sexual activity in students and significantly reduced the percentage of sexually experienced students in the schools that had the program, compared with the school that did not have the program. Four of five high schools provided the Responsible Sexuality program for all grade 9 students from 1996 to 1998, while the fifth school did not participate in the program. Students from all five schools in grades 9, 10 and 11 were given a questionnaire about their sexual activity. The results showed a statistically significant reduction, at every grade level, in the percentage of sexually active students in the four schools that had the program. Of the students in the schools that had the program, 26.9 percent reported being sexually active, compared with 44.4 percent of the students in the school that did not have the program. The researchers note that early age at onset of sexual activity and multiple sexual partners are the two major risk factors for contracting a sexually transmitted disease. Evidence exists that delaying the onset of sexual activity will reduce the number of sexual partners, thus having a positive impact on both risk factors for acquiring a sexually transmitted disease.—andrew whynot, m.d., c.c.f.p., and moira stewart, ph.d., University of Western Ontario, Parkhill, Ontario, Canada.

Nebulized Steroid Is Effective Treatment for Croup in Children

(North American Primary Care Research Group) Children treated with a nebulized steroid are significantly more likely to show an improvement in croup and are significantly less likely to require hospitalization after attending the emergency department than children receiving a placebo. This is the conclusion of a systematic review of eight randomized, controlled trials comparing administration of nebulized steroid with administration of a placebo. Data from the eight trials included 574 children with mild to severe croup. Overall, the mean age was 25.2 months and 72 percent of the participants were male. The authors recommend further research using individual patient data and community-based trials to determine the effect that severity of disease and age may have on the results.—simon griffin, m.b.b.s., et al., University of Cambridge, Cambridge, United Kingdom.

Interventions Improve Physician-Patient Communication

(21st Annual Conference on Patient Education) Educational interventions with physicians on communication skills and with patients on being more active in their care had a positive impact on physician attitudes toward communication, and physician and patient satisfaction, and decreased the length of the office visit, according to a randomized controlled trial in two clinical settings. The study included 154 physicians and 805 patients who were randomized into the following four groups: (1) physician intervention only, (2) patient intervention only, (3) patient and physician intervention or (4) no intervention. The physician intervention included three, one-day educational sessions on communications skills and one-on-one coaching sessions to practice those skills. In the patient intervention, the subjects listened to an audiotape accompanied by a guidebook that encouraged them to ask questions and report concerns to their physician. Physicians and patients filled out self-administered questionnaires at baseline, and 1- and 6-months post-physician intervention and audiotapes were made of all office visits. Results showed an increase in the satisfaction with the relationship between physician and patient among physicians, except in the patient only intervention group and the no intervention group. Female physicians and female patients tended to be more responsive to the interventions than the male physicians and male patients.—maysel kemp white, ph.d., Bayer Institute for Health Care Communication, West Haven, Connecticut.

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