Evaluation of WARN (1999-2004)
Impact of Statewide Program To Promote Appropriate Antimicrobial Drug Use. (Emerg Infect Dis. 2005 Jun;11(6):912-20.) Abstract
Knowledge, Attitudes, and Practices (KAP)
Follow-up Knowledge, Attitudes, and Practice (KAP)
Evaluating the Impact of WARN on Wisconsin Primary Care Physicians
Program Evaluation of Child Care Center Presentations and Curriculum (Feedback Surveys)
Impact of the WARN Educational Intervention for Child Care Providers
Knowledge, Attitudes, and Practices (KAP)
Public attitudes and expectations contribute to inappropriate antibiotic prescribing and antibiotic resistance. This study assessed knowledge, attitudes, and experiences regarding antibiotic use for respiratory infection or illness. A random-digit dialing telephone survey of adults and parents of children <5 years old was conducted in Wisconsin and Minnesota during 1999. 405 adults and 275 parents of children <5 years old completed the surveys. The baseline study concluded that the general public has misconceptions about when antibiotics are needed, and this may contribute to inappropriate prescribing. Providing multiple and varied antibiotic-related informational messages may increase knowledge of appropriate antibiotic prescribing and decrease patient demand for antibiotics.
Antibiotic use and upper respiratory infections: a survey of knowledge, attitudes, and experience in Wisconsin and Minnesota. (Preventive Medicine. 2002 Mar:34(3):346-52.) Abstract
Follow-up Knowledge, Attitudes, and Practice (KAP)
The follow-up KAP random digit dialing surveys for Wisconsin and Minnesota (parents and adults) were completed in August 2001. Results of random digit dialing telephone surveys in 1999 (baseline) and 2001 indicated the following:
- Knowledge of antibiotic use for respiratory illness improved significantly among adults and parents of young children.
- Fewer Wisconsin parents expected an antibiotic during a recent visit for a pediatric respiratory illness.
- College graduates were less likely to request an antibiotic.
Evaluating the Impact of WARN on Wisconsin Primary Care Physicians
In April 1999, a mailed survey of Wisconsin primary care clinicians was conducted to assess baseline knowledge, attitudes, and practices regarding antibiotic use and patient expectations for antibiotics. A total of 400 clinicians (family practice, internal medicine, pediatrics, nurse prescriber, physician assistant, emergency medicine, and general practice) were randomly selected in proportion to specialty distribution.
Major findings indicated that a significant proportion of clinicians have misconceptions regarding the significance of purulent nasal discharge and purulent sputum. Most clinicians recognized that unnecessary antibiotic use contributes to resistance, but they also felt that patients expected antibiotics for cough, cold and flu symptoms. When asked to estimate the potential reduction in antibiotic use without compromising patient care, the mean percent reduction was 16% (median=10%). Respondents stated that they could reduce their antibiotic prescribing without adversely impacting patient care.
The Minnesota Department of Health (MDH) agreed to distribute the survey to a comparable sample of 400 primary care clinicians in Minnesota for baseline information. Ruth Lynfield, MD, of the Minnesota Department of Health, coordinated the Minnesota survey. Findings suggested that patient expectation of antibiotic treatment influence antibiotic prescribing, but not satisfaction with medical care. Findings also suggest that providing multiple and varied antibiotic-related informational messages will likely increase knowledge of appropriate antibiotic prescribing and may decrease patient demand for antibiotics.
The follow-up primary care clinician survey was implemented in 2002 to compare to baseline survey data collected in 1999. This survey evaluates the impact of WARN’s multifaceted educational campaign on clinician knowledge and beliefs.
Clinician Knowledge and Beliefs after Statewide Program to Promote Appropriate Antimicrobial Drug Use (Emerg Infect Dis. 2005 Jun;11(6):904-11.) Abstract
Survey of Group and Family Child Care Centers (1999)
A baseline random-sample survey of family and group child care centers was conducted to learn about exclusion policies, how staff care for children with mild upper respiratory illnesses, and what types of educational programs would be most useful for staff and parents.
A list of licensed Wisconsin child care centers was purchased from the Wisconsin Department of Regulation and Licensing. A random sample of 10% of unduplicated centers was selected using a sampling program developed by MMRF. A cover letter co-signed by WARN and the president of the Wisconsin Child Care Administrators Association was included with the survey along with a prepaid return envelope.
Five hundred sixteen centers were included in the survey, including 283 family day cares and 233 group day cares. The overall response rate was 57% (68% for family day cares and 57% for group day cares). Almost half of family day cares and about 20% of group centers had policies requiring antibiotics for URI or ear infection before a child could return to day care. Nearly all centers were willing to distribute print materials to staff and parents. There was a high interest in educational sessions, although respondents expressed more interest in infection control rather than antibiotic resistance. Based on the feedback from the child care survey, a curriculum was developed to educate staff at child care centers on both infection control and antibiotic resistance.
Program Evaluation of Child Care Center Presentations and Curriculum (Feedback Surveys)
The WARN curriculum included a slide presentation for use at individual child care facilities and meetings of regional and statewide child care organizations. In addition, public education materials were distributed to each family and group child care center in the state.
Overall, WARN has presented information about antibiotic resistance, the prudent use of antibiotics, and infection control issues at approximately 170 child care centers in Wisconsin, reaching over 3,500 staff members. Participants received one continuing education credit hour for attending, and each child care center director received a packet of WARN materials including a copy of Wisconsin’s exclusion guidelines. Participant feedback forms were collected after each educational session and utilized for program enhancements.
Impact of the WARN Educational Intervention for Child Care Providers
Feedback survey data from child care center presentations on appropriate antibiotic use and infection control were well received. However, attendance by parents was very low and opportunities to reach parents directly in other ways were limited. Therefore, WARN initiated an educational intervention for child care providers, based on the expectation that child care providers would disseminate information and materials to parents.
To assess the impact of this educational intervention, WARN conducted a controlled, group-randomized study in licensed centers. Both intervention child care centers and control child care centers participated and distributed anonymous surveys to parents of children under 5 years of age. The intervention child care centers received the WARN educational presentation along with multiple educational materials for parents and children.
The primary objectives of the study were to determine whether child care providers pass along information and materials to parents following a presentation on appropriate antibiotic use, and whether on-site presentations to child care providers lead to improved parental knowledge, attitudes, and beliefs regarding appropriate antibiotic use and antibiotic resistance.
Donita R. Croft, MD, MS, Epidemic Intelligence Service, State Branch, Division of Applied Public Health Training, Epidemiology Program Office, CDC, led this study.
Final results have not yet been published.
