About the Get Smart Campaign

1. promoting adherence to appropriate prescribing guidelines among providers,
2. decreasing demand for antibiotics for viral upper respiratory infections among healthy adults and parents of young children, and
3. increasing adherence to prescribed antibiotics for upper respiratory infections.

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 13 in 2009 (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 print materials). Another component of the campaign was the development of materials for American Indians.

Starting in October 2008, the campaign coordinated its first national observance, Get Smart About Antibiotics Week. Get Smart About Antibiotics Week 2008 was the first effort to coordinate the work of CDC’s Get Smart: Know When Antibiotics Work campaign, state-based appropriate antibiotic use campaigns, non-profit partners, and for-profit partners during a one week observance of antibiotic resistance and the importance of appropriate antibiotic use. Through a variety of activities and resources, the messages of the Get Smart campaign were delivered. The 2009 observance took place October 5-11.

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. The curriculum is currently being reviewed, updated, and piloted by Wake Forest University School of Medicine. The curriculum should be available to all U.S. medical schools for the 2010-2011 academic year. A continuing education course consisting of six interactive, image-rich online courses to improve knowledge in understanding middle ear disease and skill in visually diagnosing middle ear effusions has been developed. The courses were developed at the Hospital of Pittsburgh/University of Pittsburgh with support from CDC. This course is available at the Children's Hospital of Pittsburgh online continuing education website. Additionally, a continuing education course titled "Improving Appropriate Antibiotic Prescribing for Acute Respiratory Infections" was developed by the Get Smart Colorado program with support from CDC. Visit the Healthcare Providers section of the website for more information about continuing education opportunities.

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:

1. 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.
2. 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, respectively, are:

1. 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.
2. Antibiotic Utilization: This measure summarizes data on outpatient utilization of drug prescriptions, stratified by age.