 A
two-day national conference was held in Sacramento California
on November 2nd and 3rd, 2002, cosponsored by theCalifornia
Medical Association [CMA] Foundation, the CDC and the
Robert Wood Johnson Foundation. The purpose of the national
conference was to identify ways to strengthen collaboration
to address appropriate antibiotic use, particularly
focusing on underserved and ethnic communities. The
conference was built on the model created by the CMA
Foundation's AWARE Project that has become a national
model for successful multisectoral collaboration.
Over 140 conference attendees from 33
states and the District of Columbia from groups including
PTA leadership, childcare organizations, community-based-organizations,
school nurse leaders, health plans, public health
representatives, medical and pharmacy associations,
the pharmaceutical industry, medical schools, and
government officials attended the conference to learn
how to better promote the appropriate use of antibiotics
in their own states and across the country.
Four goals were established to organize the format
and content of the conference:
- Expand the partnership approach of existing and
new antibiotic resistance projects.
- Increase the level of interest about the issue
of antibiotic resistance and increase commitment
to take action.
- Increase the involvement of physician, health
provider and consumer organizations in efforts to
increase appropriate antibiotic use.
- Expand the knowledge and understanding of how
antibiotic resistance and antibiotic use are impacted
by culture, ethnicity and economic status, especially
in the Latino community and among Medicaid recipients.
The conference provided a vehicle to
address a number of critical public health and medical
quality issues regarding the growing resistance to
antibiotics in the United States.
- According to the Centers for Disease Control and
Prevention, 235 million doses of antibiotics are
prescribed annually. Of these, 75% are written in
outpatient and community settings; and as many as
half of these are unnecessary. In 1998, approximately
84 million office visits were made for acute respiratory
infections in the US. Primary care physicians [pediatricians,
family practice, general practice and internists]
managed 90% of these visits and prescribed 91% of
the antibiotics. The estimated cost of these prescriptions
was $1.32 billion dollars; of which $726 million
was for excess antibiotic prescriptions. [Ralph
Gonzales, MD, et. al., Excess Antibiotic Use, Clinical
Infectious Diseases, September 15, 2001].
- There are cultural sensitivities that need to
be considered when developing interventions. Research
conducted in California shows that within the Latino
community there is a different view about the availability
and use of antibiotics. There is a significant problem
in getting antibiotics from nonclinicians, often
purchasing these at swap meets and underground "botanicas".
- Education and literacy levels influence the issue
of appropriate antibiotic use. Patients provided
health coverage through the Medicaid program also
need to receive education and awareness about this
issue. Data from a CMA Foundation statewide survey
of health consumers showed that those with lower
reading and education levels have the least understanding
of appropriate antibiotic use. Focus groups exploring
the impact of health literacy have shown how important
it is to develop education materials at the appropriate
literacy levels, listening to the language and ideas
of those we are trying to reach.
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