Antibiotics Reduction Program Spawned By GM And Michigan Blues

General Motors and Blue Cross/Blue Shield of Michigan will contribute data on antibiotic use among 600,000 patients in their Michigan health programs to a five-year project to reduce antibiotic use in the state.

According to an October analysis of its 500,000-patient database, the Michigan Blues believe that antibiotics are being prescribed eight out of ten times during visits to physicians for self-limiting upper respiratory infections. The Blues estimate approximately one of every twelve prescription dollars are spent on antibiotics.

Health Care Initiatives of General Motors reports a slightly lower antibiotic prescription rate, in the 60%-65% range for six Michigan locations.

GM and the Blues will correlate diagnoses of common cold, upper respiratory infection, acute bronchitis and bronchitis non-specified, with pharmacy claims to track the unnecessary prescribing of antibiotics.

According to a 1997 Journal of the American Medical Association article (Gonzales, et al.), 21% of all "ambulatory" antibiotic prescriptions or 12 mil. out-patient antibiotic prescriptions, were written for common cold, bronchitis and upper respiratory infection in 1992.

The two health programs are among the supporters of a year-old effort in the state to build a collaborative association aimed at controlling antibiotic us. Named the Michigan Antibiotic Resistance Reduction project, the association is attempting to link payors, community health organizations, providers, and professional and consumer education efforts to restrict antibiotic use to appropriate bacterial diagnoses.

In its formative period during the past year, the MARR project has been led by Patricia Salber, MD, Kaiser Permanente, who has been working on assignment at Health Initiatives of General Motors.

MAAR is seeking funding for the five-year community-based demonstration project and has submitted a grant proposal to the Centers for Disease Control & Prevention.

The physician awareness and education component of the MARR project will be guided by a provider intervention program from Wayne State University, called Save 100.

Save 100 has been doing physician education for two years with financial support from GM, Chrysler, the Blues and Merck-Medco. The organization conducts lectures and workshops and disseminates educational materials aimed at promoting best medical practices in the context of cost containment.

The consortium is directed by Robert Bollinger, PhD, Wayne State University, Ernest Hammel, PhD, OHEP Center for Medical Education, and Willis Stephens, MD, Michigan Infertility Center.

In a recent 100-physician survey, Save 100 queried providers on their knowledge of antibiotics costs. The results showed a tendency among physicians to underestimate the costs of expensive antibiotics and to overestimate the costs of inexpensive ones, Save 100 maintains.

"A preliminary evaluation of our methodology suggests that the Save 100 curriculum is producing an improvement in physicians' knowledge of antibiotics," the group says.

MARR will also develop and disseminate a menu of educational materials to reduce consumer demands for antibiotics.

Core messages will include "antibiotics are not useful for non-bacterial respiratory ailments; antibiotics share with other drugs the potential of causing side-effects, including allergy; promotion of bacterial resistance is an especially negative aspect of antibiotics use with individual-to-global consequences; [and] non-prescription treatments...provide relief of symptoms."

Young mothers will be especially targeted to make an impact on the pediatric population, where in 1992 "common cold, URI and bronchitis accounted for over 20% of antibiotic prescriptions given to children," the group points out.

The group will also track the antibiotic resistance of Streptococcus pneumoniae with data supplied by the Bureau of Epidemiology and Microbiology Laboratory of the Michigan Department of Community Health.

Each laboratory in the Detroit Metropolitan Statistical Area will submit 30-40 isolates per quarter for susceptibility testing and for comparison with control groups outside the MARR intervention area, in Cleveland, Ohio.