Effectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: practice based randomised controlled trial

Abstract

Objective To evaluate the effectiveness and costs of a multifaceted flexible educational programme aimed at reducing antibiotic dispensing at the practice level in primary care.Design Randomised controlled trial with general practices as the unit of randomisation and analysis. Clinicians and researchers were blinded to group allocation until after randomisation.Setting 68 general practices with about 480 000 patients in Wales, United Kingdom.Participants 34 practices were randomised to receive the educational programme and 34 practices to be controls. 139 clinicians from the intervention practices and 124 from control practices had agreed to participate before randomisation. Practice level data covering all the clinicians in the 68 practices were analysed.Interventions Intervention practices followed the Stemming the Tide of Antibiotic Resistance (STAR) educational programme, which included a practice based seminar reflecting on the practices’ own dispensing and resistance data, online educational elements, and practising consulting skills in routine care. Control practices provided usual care.Main outcome measures Total numbers of oral antibiotic items dispensed for all causes per 1000 practice patients in the year after the intervention, adjusted for the previous year’s dispensing. Secondary outcomes included reconsultations, admissions to hospital for selected causes, and costs.Results The rate of oral antibiotic dispensing (items per 1000 registered patients) decreased by 14.1 in the intervention group but increased by 12.1 in the control group, a net difference of 26.1. After adjustment for baseline dispensing rate, this amounted to a 4.2% (95% confidence interval 0.6% to 7.7%) reduction in total oral antibiotic dispensing for the year in the intervention group relative to the control group (P=0.02). Reductions were found for all classes of antibiotics other than penicillinase-resistant penicillins but were largest and significant individually for phenoxymethylpenicillins (penicillin V) (7.3%, 0.4% to 13.7%) and macrolides (7.7%, 1.1% to 13.8%). There were no significant differences between intervention and control practices in the number of admissions to hospital or in reconsultations for a respiratory tract infection within seven days of an index consultation. The mean cost of the programme was £2923 (€3491, $4572) per practice (SD £1187). There was a 5.5% reduction in the cost of dispensed antibiotics in the intervention group compared with the control group (−0.4% to 11.4%), equivalent to a reduction of about £830 a year for an average intervention practice.Conclusion The STAR educational programme led to reductions in all cause oral antibiotic dispensing over the subsequent year with no significant change in admissions to hospital, reconsultations, or costs.Trial registration ISRCT No 63355948.

Training family physicians in shared decision-making to reduce the overuse of antibiotics in acute respiratory infections: a cluster randomized trial

“…25 In another recent study, a combination of online educational modules and a seminar on motivational interviewing led to a reduction in dispensing of oral antibiotics with no significant change in admissions to hospital, repeat consultations or costs. 26 These studies indicate that a combination of live and media education are generally effective in changing physician performance in the context of antibiotic use for acute respiratory infections. 27 These findings are important given the debate and widespread skepticism about the effect of medical education on the performance of physicians in the practice setting.…”

“…• Out of 213 patients, 178 eligible patients consulted 72 physicians; median practice size = 16 physicians, range [14][15][16][17][18][19][20][21][22][23][24][25][26] Units included in the intervention group n = 5 teaching units. We excluded physicians who had participated in the DECISION+ pilot trial 13 or who did not expect to practise in the teaching unit during the trial period.…”

Shared decision making in primary care: barriers and facilitators of shared decision making in the context of decreasing the use of unnecessary antibiotics for preschool children ages 3-5 with upper respiratory tract infections

“…Antibiotics that were reduced were those used commonly for URIs (Butler et al, 2012). There was no reported increase in hospital admissions or reconsulting associated with decreased antibiotic prescriptions.…”

“…Research by Butler et al (2012) demonstrated the effectiveness of shared decision making included in educational interventions as a cost-effective method of decreasing unnecessary antibiotic use. Antibiotics that were reduced were those used commonly for URIs (Butler et al, 2012).…”

“…Seven articles were chosen to further examine facilitators of shared decision making (Brookes-Howell et al, 2014;Butler et al, 2012;Giguere et al, 2012;Hoye et al, 2010;Legare et al, 2013;Legare et al, 2012;Mangione-Smith et al, 2015). Giguere et al (2012) and Butler et al (2012) provided research on the effects of shared decision making education targeted towards PCPs on antibiotic prescribing trends. Research by Legare et al (2012) and Legare et al (2013) explored the implementation of shared decision making education into primary care settings.…”