Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial

Abstract

SummaryBackgroundHigh-volume prescribing of antibiotics in primary care is a major driver of antibiotic resistance. Education of physicians and patients can lower prescribing levels, but it frequently relies on highly trained staff. We assessed whether internet-based training methods could alter prescribing practices in multiple health-care systems.MethodsAfter a baseline audit in October to December, 2010, primary-care practices in six European countries were cluster randomised to usual care, training in the use of a C-reactive protein (CRP) test at point of care, in enhanced communication skills, or in both CRP and enhanced communication. Patients were recruited from February to May, 2011. This trial is registered, number ISRCTN99871214.ResultsThe baseline audit, done in 259 practices, provided data for 6771 patients with lower-respiratory-tract infections (3742 [55·3%]) and upper-respiratory-tract infections (1416 [20·9%]), of whom 5355 (79·1%) were prescribed antibiotics. After randomisation, 246 practices were included and 4264 patients were recruited. The antibiotic prescribing rate was lower with CRP training than without (33% vs 48%, adjusted risk ratio 0·54, 95% CI 0·42–0·69) and with enhanced-communication training than without (36% vs 45%, 0·69, 0·54–0·87). The combined intervention was associated with the greatest reduction in prescribing rate (CRP risk ratio 0·53, 95% CI 0·36–0·74, p<0·0001; enhanced communication 0·68, 0·50–0·89, p=0·003; combined 0·38, 0·25–0·55, p<0·0001).InterpretationInternet training achieved important reductions in antibiotic prescribing for respiratory-tract infections across language and cultural boundaries.FundingEuropean Commission Framework Programme 6, National Institute for Health Research, Research Foundation Flanders.

Cost effectiveness of amoxicillin for lower respiratory tract infections in primary care: an economic evaluation accounting for the cost of antimicrobial resistance

“…6,36 Mechanisms for better targeting include the use of delayed prescribing, training, and diagnostic tools, which have been shown to be effective. [37][38][39][40] The results of this study highlight the great importance that should be attached to additional research into improved methods for estimating the costs associated with resistance, but also suggest that there is a possibility that prescription of antibiotics for LRTI may not be cost effective. The authors' final recommendation is that all economic evaluations of interventions where antibiotics are used should attempt to incorporate a cost for resistance.…”

Access to Point-of-Care Tests Reduces the Prescription of Antibiotics Among Antibiotic-Requesting Subjects With Respiratory Tract Infections

“…However, training in communication skills, which has been shown to effectively deal with patients without prescribing antibiotics in other studies, was not carried out in the HAPPY AUDIT study. [19][20][21] Only those GPs assigned to the full intervention group significantly reduced the amount of antibiotics prescribed after the intervention had taken place. The only difference between the full and the partial intervention groups was the access to rapid tests, and this was associated with a 18.9% reduction in antibiotic prescribing.…”

Designing and Undertaking a Health Economics Study of Digital Health Interventions

“… literature reviews, summarizing available evidence on:  costs of user experience testing These costs can be substantial, ranging from £20,000 (for a simple one-session intervention) 32 to £500,000 (or more) for a longitudinal, highly interactive intervention with extensive content, tailored to many different variables. 33 Many of these costs relate to iterative development and evaluation of the intervention to maximize acceptability and feasibility.…”