DUR: Alliance Working for Antibiotic Resistance Education (AWARE)
The Medi-Cal Drug Use Review (DUR) program is actively involved in developing and supporting educational efforts to describe best practices in drug therapy. The DUR board’s current activities include: an atypical antipsychotics project, arthritis and asthma data analysis, and data and consulting support regarding antibiotic overuse. Each of these efforts is driven by federally mandated goals to improve the quality of health care and reduce the costs related to drug therapy.
The AWARE Program
In January 2000, the California Medical Association (CMA) Foundation embarked on a multi-year, statewide effort to promote the appropriate use of antibiotics for respiratory tract infections. The Alliance Working for Antibiotic Resistance Education (AWARE) is a partnership that includes physician organizations; health care providers; health plans; public health agencies; consumer and community-based organizations; federal, state and local governments; and the pharmaceutical industry. The California Pharmacists Association and the California Society of Health-Systems Pharmacists, together with more than 80 other organizations, are part of AWARE’s statewide coalition, with more than 200 volunteers from these groups actively involved in AWARE activities.
Compendium of Clinical Practice Guidelines
In 2001, the CMA Foundation conducted a survey of primary care physicians, interviewing 150 physicians throughout the state. Over 75 percent of the physicians surveyed felt that a compendium of clinical practice guidelines would be an extremely useful tool in their practice. Physicians indicated that a tool organizing and summarizing key practice guidelines could be of great assistance, as well as help to reduce unnecessary antibiotic prescribing.
The CMA Foundation’s AWARE Project developed the Compendium of Clinical Practice Guidelines for acute respiratory infections in response to this need. The compendium helps organize and summarize key practice guidelines and antibiotic prescribing recommendations. It is a presentation designed to aid clinicians and pharmacists in understanding current practices in antibiotic prescribing for five areas: Otitis media (pediatric version), acute bacterial sinusitis, pharyngitis, acute bronchitis and
non-specific upper respiratory infection. According to the Centers for Disease Control and Prevention, these indicators comprise the bulk of antibiotic prescriptions in the state and nation.
To date, more than 70,000 copies of the October 2003 edition of the Clinical Compendium have been distributed in California, and it will be updated on a yearly basis to reflect new scientific findings in the field of antibiotic prescribing for acute respiratory infections. There is an accompanying Continuing Medical Education (CME) program that will help introduce the compendium into practice.
The CME program also introduces clinicians and pharmacists to accompanying patient education materials. The program, which offers reliable information about the latest ideas for prescribing antibiotic medications, is widely available with one hour of CME credit provided by the University of California, Davis, Health System Continuing Medical Education.The Role of Pharmacists
Pharmacists are on the front lines of the appropriate antibiotic prescribing movement. As an important link between health care provider and patient, the pharmacist can distribute flyers, called “bag stuffers,” with prescription medication bags from the pharmacy. There are also many public speaking engagements through AWARE’s Speakers Bureau. It is an opportunity to promote the importance of the pharmacist within the community as well as acclimate patients to the understanding that antibiotics must be used wisely and with care. Studies have shown that resistance rates decline when antibiotics are prescribed appropriately.
The Medi-Cal Drug Use Review Board and the Department of Health Care Services are pleased to partner with the AWARE Project in the promotion of appropriate antibiotic prescribing. When antibiotics are used appropriately, everyone benefits.
For more information about the Clinical Compendium of Appropriate Prescribing Guidelines or to host a CME presentation, contact Anne M. Judson, AWARE Project Coordinator, at (916) 551-2543 or via e-mail at ajudson@cmanet.org. In addition, there are numerous resources for pharmacists and other health care providers, including posters, patient education handouts and a public speakers bureau, available through the AWARE Web site.