Our abstracted data include diagnosis; presence or absence of specific key diagnostic criteria in the case of sinusitis, otitis media, or pharyngitis; whether an antibiotic was prescribed or not; and if an antibiotic was prescribed, which one (to assess use of narrow- vs. broad- spectrum antibiotics).

Second, future Oregon BRFSS data will provide valuable information about changes in public knowledge about safe antibiotic use and expectations surrounding the receipt of antibiotics to treat upper respiratory infections.
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Third, annual analysis of prescribing trends in the Oregon Medicaid fee-for-service population will continue to shed light on clinician prescribing behaviors. This analysis will allow comparisons between prescribing rates in the general community as opposed to those in the residency clinics assessed as part of the curriculum project.

Finally, we hope to analyze trends in two new measures in the Health Plan Employer Data Information Set (HEDIS®) related to appropriate treatment of children with upper respiratory infections and appropriate testing for pediatric pharyngitis.

Conclusion
Effecting change in antibiotic use requires interventions at multiple levels to all types of health care professionals and to lay audiences. These interventions work best when performed in different settings (e.g., community health talks, education forums for health professionals, or media messages), and through the combined efforts of both public health and medical education organizations. Physicians and other clinicians play a key role in education their patients about the dangers of inappropriate antibiotic use, how and when to use antibiotics appropriately, and how best to care for symptoms caused by viral pathogens. To do this effectively, clinicians must possess good communication skills to use in eliciting the patients’ true concerns, in educating patients both directly and through printed or Web-based materials, and in negotiating with patients when antibiotics are not indicated. Given the time constraints common in today’s outpatient environment, they must also have easy access to high-quality patient education materials that can reinforce verbal messages and reduce the time needed for direct education.

The programs described in this article provide a wide range of educational opportunities for both clinicians and lay audiences. Many of them are intended to empower clinicians to educate their patients about this important public health issue. By pursuing these avenues, we expect clinicians to become much more active in this area of health promotion.