ple, they have a responsibility to provide adequate time as well as incentives for physicians to participate in educational activities. Some managed care organizations have developed practice guidelines based on published principles. Other professional organizations are tracking the rates of antibiotic use among physicians and are directing their interventions toward those providers who prescribe the most antibiotics. For example, Kaiser Permanente provides economic incentives by reimbursing patients for medications judiciously prescribed in an effort to reduce the level of prescription medication use. In Michigan and Tennessee, the driving force for educational initiatives has primarily come from health plan purchasers. In Colorado, a statewide coalition that addresses antibiotic resistance was established after the state legislature considered a bill that would have punished physicians for antibiotic overuse. Various approaches to intervention can be effective in changing practices. Because managed care organizations have an incentive to reduce inappropriate antibiotic use, as well as halt the spread and mitigate the impact of antimicrobial resistance, they should be encouraged to address this problem in ways that fit their capabilities. Considering the range of policies that affect antibiotic use practices, changing those that act as disincentives to judicious antibiotic use may also be an important component of an intervention (IOM, 1998).

EDUCATION AND OUTREACH PERSPECTIVES OF THE NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

Presented by Karl Western, M.D.

Assistant Director for International Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health

Unlike health maintenance organizations and managed care organizations, the National Institute of Allergy and Infectious Diseases (NIAID) has focused on promoting the basic scientific underpinnings of clinical research instead of direct educational and outreach activities to the medical community. In response to public concern, NIAID has encouraged the development of strengthened capabilities in research on emerging and reemerging infectious diseases. It has primarily exercised such efforts by providing targeted administrative supplements to extramural research awards and by encouraging investigators and centers to submit Emerging and Reemerging Infectious Diseases applications in response to program announcements or requests for applications. These efforts specifically call for networking of the scientific community and have resulted in three new Emerging Virus Centers and four Hepatitis C Research Centers, which will form a research network in those areas.

Additionally, emerging infections were a prominent feature in NIAID's International Collaboration in Infectious Disease Research. Through these and other initiatives, NIAID hopes to prepare NIH-supported groups to cooperate



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