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 infectiousdiseases. However, antibiotic overuse is the key driver of drug resistance.Previously published studies have suggested benefits of using peer-topeereducation, working with group leaders to build trust and maintainconfidentiality within a quality initiative. We hypothesized that workingwith physicians as a peer group might be beneficial in influencing antibioticprescribing patterns. Objective: To describe and evaluate a peer group model for an interventionto reduce the volume of antibiotic prescriptions among physicians withabove average prescribing rates serving an Arab community in northernIsrael. Methods: Primary care physicians in a defined geographic area whoserved Arab communities and had high antibiotic prescribing rates-defined as above average number of antibiotic prescriptions per office visitcompared with regional and organizational averages-were recruited forthe intervention. All other physicians from the same region served as acomparison group. The intervention was administered during 2007 and wascompleted in early 2008. Four structured meetings scheduled 2 monthsapart, in which the group explored the issues related to antibiotic overuse,included the following topics: adherence to clinical guidelines; the specialposition physicians serving Arab communities hold and the influence it hason their practices; pressure due to consumer demands; and suggestions forpossible strategies to face ethnic sensitivity, mainly because of the specialties the physicians have with their communities. T-tests for independentsamples were used to perform between-group comparisons for each quarterand year of observation from 2006 through 2010, and t-tests for pairedsamples were used to compare pre-intervention with post-interventionantibiotic prescribing rates. Results: In the 2006 pre-intervention period, the antibiotic prescribingrates were 0.17 for the peer group (n = 11 physicians) and 0.15 for the comparisongroup (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-testanalysis, rates declined significantly from 2006 to 2008 in the interventiongroup (P < 0.001) but not in the comparison group (P = 0.138). Antibioticprescribing rates remained similar in 2009 and 2010. Conclusion: In the context of a community with special ethnic and culturalcharacteristics, an intervention relying on peer group techniques was associatedwith a modest reduction in the volume of antibiotic prescriptions.