Optimizing antibiotic prescribing for acute cough in general practice: a cluster-randomized controlled trial

Coenen, Samuel; Royen, Paul Van; Michiels, Bart; Denekens, Joke

doi:10.1093/jac/dkh374

Cited by 79 publications

(111 citation statements)

References 40 publications

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“…[12][13][14]16,17,23,24 However, this is the first study, to our knowledge, to assess the effect of educational outreach visits on prescribing by GDPs. A significant reduction in the number of antibiotic prescriptions issued by dentists in the intervention group compared to dentists in the control and guideline groups was obtained following educational outreach visits by a pharmacist.…”

Section: Discussionmentioning

confidence: 99%

A randomised controlled trial of clinical outreach education to rationalise antibiotic prescribing for acute dental pain in the primary care setting

et al. 2006

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Section: Discussionmentioning

confidence: 99%

A randomised controlled trial of clinical outreach education to rationalise antibiotic prescribing for acute dental pain in the primary care setting

et al. 2006

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“…31 Finally, during a randomised study in Belgium, patients were less likely to receive antibiotics in the group of GPs who received an educational visit based on guidelines, than in controls. 37 Few randomised studies have evaluated the impact of medical education programmes on medical practice using an appropriate methodology. 38,39 It was recently pointed out that multiple interventions are more effective than interventions limited to a single element.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Long-term effects of an educational seminar on antibiotic prescribing by GPs: a randomised controlled trial

Corvoisier

Renard²,

Roudot‐Thoraval³

et al. 2013

Br J Gen Pract

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BackgroundHigh levels of outpatient antibiotic use remain observed in many European countries. Several studies have shown a strong relationship between antibiotic use and bacterial resistance. AimTo assess the long-term effect of a standardised educational seminar on antibiotic prescriptions by GPs. Design and settingRandomised controlled trial of 171 GPs (of 203 initially randomised) in France. MethodGPs in the control group (n = 99) received no antibiotic prescription recommendation. Intervention group GPs (n = 72) attended an interactive seminar presenting evidencebased guidelines on antibiotic prescription for respiratory infections. The proportion of prescriptions containing an antibiotic in each group and related costs were compared to the baseline up to 30 months following the intervention. Data were obtained from the National Health Insurance System database. ResultsIn the intervention group, 4-6 months after the intervention, there was a significant decrease in the proportion of prescriptions containing an antibiotic from 15.2 ± 5.4% to 12.3 ± 5.8% (-2.8% [95% CI = -3.8 to -1.9], P<0.001). By contrast, an increase was observed in controls from 15.3 ± 6.0 to 16.4 ± 6.7% (+1.1% [95% CI = +0.4 to +1.8], P<0.01), resulting in a between-group difference of 3.93% ([95% CI = 2.75 to 5.11], P<0.001). The between-group difference was maintained 30 months after intervention (1.99% [95% CI = 0.56 to 3.42], P<0.01). Persistence of the intervention effect over the entire study period was confirmed in a hierarchical multivariate analysis. ConclusionThis randomised trial shows that a standardised and interactive educational seminar results in a long-term reduction in antibiotic prescribing and could justify a large-scale implementation of this intervention.

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“…[3][4][5] However, they have generally been designed for implementation in a single context 6,7 and have focused on a single country, health care organisation and culture.…”

Section: Introductionmentioning

confidence: 99%

Clinicians’ Views and Experiences of Interventions to Enhance the Quality of Antibiotic Prescribing for Acute Respiratory Tract Infections

et al. 2014

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BACKGROUND: Evidence shows a high rate of unnecessary antibiotic prescriptions in primary care in Europe and the United States. Given the costs of widespread use and associated antibiotic resistance, reducing inappropriate use is a public health priority. OBJECTIVE: We aimed to explore clinicians' experiences of training in communication skills and use of a patient booklet and/or a C-reactive protein (CRP) point-of-care test to reduce antibiotic prescribing for acute respiratory tract infections (RTIs). DESIGN: We used a qualitative research approach, interviewing clinicians who participated in a randomised controlled trial (RCT) testing two contrasting interventions. PARTICIPANTS: General practice clinicians in Belgium, England, The Netherlands, Poland, Spain and Wales participated in the study. APPROACH: Sixty-six semi-structured interviews were transcribed verbatim, translated into English where necessary, and analysed using thematic and framework analysis. KEY RESULTS: Clinicians from all countries attributed benefits for themselves and their patients to using both interventions. Clinicians reported that the communication skills training and use of the patient booklet gave them greater confidence in addressing patient expectations for an antibiotic by providing answers to common questions and supporting the clinician's own explanations. Clinicians felt the booklet could be used for a variety of patients and for different types of infections. The CRP test was viewed as a tool to decrease diagnostic uncertainty, to support non-prescription decisions, and to reassure patients, but was only necessary when clinicians were uncertain about the need for antibiotics. CONCLUSION: Providing clinicians with training and support tools for use in practice was received positively and was valued by clinicians across countries. Interventions seemed to have influenced behaviour by increasing clinician knowledge about illness severity and prescribing, increasing confidence in making non-prescribing decisions when antibiotics were unnecessary, and enabling clinicians to anticipate positive outcomes when making such decisions. Addressing such determinants of behaviour change enabled interventions to be relevant for clinicians working across different contexts.

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Optimizing antibiotic prescribing for acute cough in general practice: a cluster-randomized controlled trial

Abstract: An (inter)actively delivered tailored intervention implementing a guideline for acute cough is successful in optimizing antibiotic prescribing without affecting patients' symptom resolution. Further research efforts should be devoted to cost-effectiveness studies of such interventions.

Cited by 79 publications

References 40 publications

A randomised controlled trial of clinical outreach education to rationalise antibiotic prescribing for acute dental pain in the primary care setting

A randomised controlled trial of clinical outreach education to rationalise antibiotic prescribing for acute dental pain in the primary care setting

Long-term effects of an educational seminar on antibiotic prescribing by GPs: a randomised controlled trial

Clinicians’ Views and Experiences of Interventions to Enhance the Quality of Antibiotic Prescribing for Acute Respiratory Tract Infections

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