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In response to the growing problem of antibiotic-resistant bacteria and the safety risks and unnecessary treatment costs posed by these "superbugs," the Coalition for Affordable Quality Healthcare, a group of 24 health plans and insurers, has joined with the Centers for Disease Control and Prevention to initiate a broad-based campaign to preserve the strength of existing antibiotic treatments. The Save Antibiotic Strength campaign aims to decrease overuse and misuse of antibiotics by reducing the number of inappropriate antibiotic prescriptions and by promoting the use of first-line antibiotics.
Kicked off in Washington on April 17th, the campaign incorporates the efforts of the CAQH, the CDC, and partners such as state health departments, academic medical centers, and national organizations such as the American Academy of Pediatrics and the American Academy of Family Physicians to develop and distribute guidelines and educational materials both nationally and locally.
On the national level, information and articles on the subject will appear in CAQH health plans' member, physician and group employer newsletters. To raise awareness in the general public, CAQH medical directors will conduct radio interviews to be aired nationwide. Participating doctors will receive a number of educational tools, such as posters and patient handouts. "Prescription" pads explain to patients why antibiotics are unnecessary and ineffective in treating viral infection, and recommend comfort measures, such as throat lozenges and saline nasal spray, that doctors can check off depending on patients' specific symptoms. Letters for parents to give to day care center personnel explain why the child is not being treated with antibiotics and provide treatment advice. According to Brooke Taylor, Richmond, VA-based Trigon Healthcare Inc.'s vice president of corporate communications and deputy board member to the CAQH, these tools are particularly important in reducing the pressure physicians receive from patients to prescribe antibiotics. "It lays the groundwork with the patient so that the doctor doesn't have to start from ground zero in trying to explain to someone who feels miserable why they really don't need an antibiotic." Taylor added that these tools can also reduce patient frustration: "It helps remind them of what they should do to help themselves feel better, and it also gives them something they can walk away with in their hand."
Locally, the SAS campaign will target three specific areas: San Diego, CA, Norfolk, VA and Connecticut. In these regions, CAQH health plans, hospital systems, physicians and departments of health will collaborate in educational outreach programs, as well as local advertising. Also, in these areas, aggregate claims data from CAQH health plans will be tracked to measure the impact of the program. According to Sam Ho, vice president, corporate medical director for Pacificare Health Systems, Santa Ana, CA and chairman of the SAS Quality Initiative Work Group, a baseline measurement from the second quarter of 2000 to the first quarter of 2001 will be compared with data collected next year to obtain a "composite snapshot of antibiotic use in these three areas before the initiative was launched and after the initiative was launched to assess performance and potential improvement in those areas."
Focusing specifically on sore throat symptoms in patients 16 and under, health plans will monitor how often strep tests are done to determine whether infections are bacterial or viral and, when needed, how often the appropriate first-line antibiotic is prescribed. Claims data measured will not indicate specific doctors or health plans. Said Brooks, "We're looking at the total picture from a public health standpoint more than from a doctor-specific standpoint."
Beyond the coalition's national educational and local measurement efforts, many participating insurers and health plans are implementing, or continuing to implement, their own supplemental programs, separate but complimentary to the overall initiative. For instance, Ho noted that in addition to educational materials provided by SAS, Pacificare distributes antibiotic tool kits, including wall charts to guide doctors in prescribing first-line versus second-line antibiotics, and "counter-detailing" kits, which include samples of products like facial tissue, tea bags, and over-the-counter cough and cold remedies as an alternative to antibiotic drug samples. Also, unlike the coalition as a whole, Pacificare's program includes individual profiling of the prescribing habits of medical groups and, later, physicians.
Many of the CAQH health plans have had pilot programs to preserve antibiotic strength in place for years. In the past year, Trigon initiated its own educational outreach program and measured antibiotic prescribing for rhinitis and sinusitis in its local markets. Taylor described plans' decision to join the campaign as an expansion of these efforts, "an opportunity for all of us to get together and be able to do something as a group that could be far more meaningful than what we could do individually." PR