Improving antibiotic prescribing in acute respiratory tract infections: cluster randomised trial from Norwegian general practice (prescription peer academic detailing (Rx-PAD) study)

Abstract

Objective To assess the effects of a multifaceted educational intervention in Norwegian general practice aiming to reduce antibiotic prescription rates for acute respiratory tract infections and to reduce the use of broad spectrum antibiotics.Design Cluster randomised controlled study.Setting Existing continuing medical education groups were recruited and randomised to intervention or control.Participants 79 groups, comprising 382 general practitioners, completed the interventions and data extractions.Interventions The intervention groups had two visits by peer academic detailers, the first presenting the national clinical guidelines for antibiotic use and recent research evidence on acute respiratory tract infections, the second based on feedback reports on each general practitioner’s antibiotic prescribing profile from the preceding year. Regional one day seminars were arranged as a supplement. The control arm received a different intervention targeting prescribing practice for older patients.Main outcome measures Prescription rates and proportion of non-penicillin V antibiotics prescribed at the group level before and after the intervention, compared with corresponding data from the controls.Results In an adjusted, multilevel model, the effect of the intervention on the 39 intervention groups (183 general practitioners) was a reduction (odds ratio 0.72, 95% confidence interval 0.61 to 0.84) in prescribing of antibiotics for acute respiratory tract infections compared with the controls (40 continuing medical education groups with 199 general practitioners). A corresponding reduction was seen in the odds (0.64, 0.49 to 0.82) for prescribing a non-penicillin V antibiotic when an antibiotic was issued. Prescriptions per 1000 listed patients increased from 80.3 to 84.6 in the intervention arm and from 80.9 to 89.0 in the control arm, but this reflects a greater incidence of infections (particularly pneumonia) that needed treating in the intervention arm.Conclusions The intervention led to improved antibiotic prescribing for respiratory tract infections in a representative sample of Norwegian general practitioners, and the courses were feasible to the general practitioners.Trial registration Clinical trials NCT00272155.

Intervention to improve the quality of antimicrobial prescribing for urinary tract infection: a cluster randomized trial

“…Another Norwegian study to limit antimicrobial prescribing for respiratory infections used an RCT design to implement multifaceted academic detailing as part of continuing medical education. 16 In this RCT, there was better adherence to guidelines and a reduction in antimicrobial prescribing, which suggests that changing the prescribing behaviour of general practitioners should be integrated into their continuing education. A recent simple and low-cost RCT showed great promise in reducing inappropriate prescribing through the use of public commitment letters from general practitioners, without additional support; there was an absolute reduction of nearly 20% in inappropriate prescribing of antimicrobials, which did not diminish over the 1-year duration of the study.…”

Electronic Health Records for Intervention Research: A Cluster Randomized Trial to Reduce Antibiotic Prescribing in Primary Care (eCRT Study)

“…23,24 Multifaceted interventions are increasingly developed and tested in primary care, with evidence of effectiveness at reducing antibiotic prescribing. [25][26][27] These more intensive and costly interventions may be impractical for widespread application and their long-term effectiveness uncertain. Our study shows that a system for computer-delivered decision support delivered remotely to many practices, so that prescribers would have links to evidence-based information, may be expected to have a smaller, but significant, effect in reducing antibiotic prescribing.…”

Knowledge About Prescribing Antibiotics for Patients With Acute Pharyngitis and Its Associate Factors Among Primary Health Care Physicians at Ministry of Health Makkah Al-Mukarramah City, 2016.

“…(4) one of them is prescribing antibiotic inappropriately. (5) This study aimed to assess the knowledge and associated factors regarding prescribing antibiotics for patients with acute pharyngitis among primary health care (PHC) physicians at Ministry of Health (MOH) in the Holy city of Makkah, 2016.…”