Get Smart: Campaign Information
Know When Antibiotics Work
Why does CDC have an appropriate antibiotic use campaign? |
Antimicrobial resistance among respiratory pathogens has become a common clinical problem, and the association of resistance with the use of antimicrobial drugs has been documented in both inpatient and outpatient settings. The Institute of Medicine has identified antibiotic resistance (exit site) as one of the key microbial threats to health in the United States and has listed decreasing the inappropriate use of antimicrobials as a primary solution to address this threat. For this reason, antibiotic resistance is among CDC's top concerns.
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What are the campaign's objectives? |
CDC launched the National Campaign for Appropriate Antibiotic Use in the Community in 1995. In 2003, this program was renamed Get Smart: Know When Antibiotics Work in conjunction with the launch of a national media campaign. This campaign aims to reduce the rate of rise of antibiotic resistance by:
- promoting adherence to appropriate prescribing guidelines among providers,
- decreasing demand for antibiotics for viral upper respiratory infections among healthy adults and parents of young children, and
- increasing adherence to prescribed antibiotics for upper respiratory infections.
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Why focus on upper respiratory infections? |
Upper respiratory infections account for three quarters of all antibiotics prescribed by office-based physicians. If antibiotics were always prescribed appropriately, the resulting increase in resistance could be seen as inevitable and unavoidable. However, antibiotics are often used inappropriately. Even though prescribing rates have decreased, current data suggest that, for all ages combined, more than ten million courses of antibiotics are prescribed each year for viral conditions that do not benefit from antibiotics.
The Get Smart campaign targets the five respiratory conditions that in 1992 accounted for more than 75% of all office-based prescribing for all ages combined: otitis media, sinusitis, pharyngitis, bronchitis, and the common cold.
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Who are the target audiences of the campaign? |
The target audiences for this campaign include patients and providers since knowledge, attitudes, skills, and behaviors of both patients and providers contribute to antibiotic prescribing and antibiotic use. Because antibiotic prescribing is highest for young children, the primary audience consists of parents of young children. Healthy adults under 50 years of age are an additional target audience.
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What are the campaign's activities? |
Developing and distributing materials
One of the initial products of CDC's campaign was the development and distribution of principles for appropriate antibiotic use for pediatric upper respiratory tract infections. These guidelines were developed in collaboration with the American Academy of Pediatrics and members of the American Academy of Family Physicians. CDC then collaborated with members of the American Academy of Family Physicians, American College of Physicians, Infectious Disease Society of America, and the America College of Emergency Physicians to develop principles of appropriate antibiotic use for adult respiratory tract infections. The pediatric and adult guidelines provide a definition of appropriate prescribing and have been distributed to numerous state and local health departments, health plans, physician groups and others.
CDC also produced a series of health education and behavioral change materials for both patients and providers to promote appropriate antibiotic use. These include brochures, posters, question and answer fact sheets for parents on runny nose and otitis media, instructional or detailing sheets for small group physician education modeled after materials used by the pharmaceutical industry, a day care letter, a prescription adherence sheet, and a viral/symptomatic prescription pad. The prescription pad in particular has been extremely popular and useful as a communication tool. Healthcare providers can use this tool to recommend strategies for symptomatic relief of viral illnesses, thereby acknowledging the patient's discomfort and suggesting solutions without prescribing an antibiotic unnecessarily.
Funding sites and providing technical assistance to develop, implement, and evaluate local campaigns.
CDC distributes federal funds to state and local health departments for the development, implementation, and evaluation of local campaigns to promote appropriate antibiotic use. Beginning in 2000 with only 8 sites, CDC increased the number of funded sites to 16 in 2008 (view map of funded sites). Technical assistance to support these funded sites includes: identifying resources, sharing new scientific and educational information, facilitating networking and the formation of partnerships, and conducting monthly phone calls to track progress and identify program needs.
Implementing a national media campaign
CDC has developed a national media campaign in partnership with the Food and Drug Administration (FDA) to provide a coordinated message on appropriate antibiotic use and create a foundation for local efforts across the country. Using the tagline Get Smart: Know When Antibiotics Work , the campaign was launched on September 17, 2003 and was disseminated through print, television, radio and outdoor media (virtual press kit). The campaign's materials have been revised to incorporate the new logo and tagline, and these materials and media toolkits were distributed to CDC-funded sites for use in conjunction with their local campaigns. On January 6, 2005, two additional components of the campaign were launched. These include materials for healthy adults (ages 18-50 years) and additional materials for Spanish speakers (campaign materials). Another component of the campaign was the development of materials for American Indians.
Securing funding for and promoting the adoption of provider curricula
CDC developed an appropriate antibiotic use curriculum for medical students in collaboration with Westat (a research organization) and the University of California, San Diego. In 2005, the curriculum was pilot tested and distributed to 25 medical schools. The curriculum will be available to all U.S. medical schools in late 2009. A tool to increase proficiency in the diagnosis of acute otitis media by pediatric and family practice residents was developed by the Children's Hospital of Pittsburgh. The acute otitis media curriculum is available at the Children's Hospital of Pittsburg online continuing education website.
Developing and testing Healthcare Effectiveness Data and Information Set (HEDIS® ) performance measures
CDC and the National Committee on Quality Assurance have written two pediatric and two adult Healthcare Effectiveness Data and Information Set ( HEDIS ® ) measures. HEDIS® is a performance measurement tool used by over 90 percent of the nation's health plans. Experts in appropriate antibiotic use collaborated with a multidisciplinary team of researchers with expertise in the development and testing of HEDIS® measures to develop these measures. The pediatric measures, which were incorporated into HEDIS® in 2004, are:
- Appropriate testing for children with pharyngitis: percentage of children 2 to 18 years of age who were diagnosed with pharyngitis, prescribed an antibiotic and received a group A streptococcus (strep) test for the episode.
- Appropriate treatment for children with upper respiratory infection (URI): percent of children 3 months to 18 years of age with a diagnosis of URI who were not prescribed antibiotics on or three days after the episode date.
The adult measures, which were incorporated into HEDIS® in 2006 and 2008 are:
- Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (inverted the measure rate and renamed measure for 2008). Adults diagnosed with acute bronchitis who were not dispensed an antibiotic prescription.
- Antibiotic Utilization: This measure summarizes data on outpatient utilization of drug prescriptions, stratified by age.
This measure evaluates many factors, including:
- total number of antibiotic prescriptions
- average number of antibiotic prescriptions per member per year
- total days supplied for all antibiotic prescriptions
- average number of days supplied per antibiotic prescription
- total number of prescriptions per member per year for antibiotics of concern
- average number of prescriptions per member per year reported by drug class for selected “antibiotics of concern” and for all other antibiotics
- percentage of antibiotics of concern of total antibiotic prescriptions
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Who works on the campaign? |
The Get Smart campaign is headed by a Medical Director. Health educators and communication specialists provide technical assistance and support in the development, implementation, and evaluation of local campaigns in funded states and counties, among other duties. If you are interested in contacting the staff, please e-mail getsmart@cdc.gov.
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What awards has the campaign won? |
In both 2002 and 2003 the campaign was recognized by the Public Health Education and Promotion Network (PHEP-Net), a CDC organization, with the Merit Award for Outstanding Effort in Disease Prevention and Control and the Distinguished Health Education Program Award respectively.
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How can you get involved in the campaign? |
There are many partners that support the campaign in a variety of ways. Please visit our Partners page to learn more.
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