The Antimicrobial Treatment Strategies (MIKSTRA) Program: A 5-Year Follow-Up of Infection-Specific Antibiotic Use in Primary Health Care and the Effect of Implementation of Treatment Guidelines

Rautakorpi, Ulla-Maija; Huikko, Solja; Honkanen, Pekka; Klaukka, Timo; Mākelä, Marjukka; Palva, Erkki; Roine, Risto P.; Sarkkinen, Hannu; Varonen, Helena; Huovinen, Pentti

doi:10.1086/503036

Cited by 52 publications

(55 citation statements)

References 27 publications

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“…In Finland, a controlled study analysed the effect of guideline dissemination through local interactive discussion groups: no reduction in antibiotic prescription was observed during the 5-year follow-up. 36 In Switzerland, a similar lack of efficacy was reported for an interactive seminar on guidelines with and without a patientcentred communication conference. 20 However, other authors have reported more positive results.…”

Section: Comparison With Existing Literaturementioning

confidence: 72%

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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Section: Comparison With Existing Literaturementioning

confidence: 72%

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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“…38 In Finland, a recent intervention was unsuccessful at changing the fraction of infections that were treated with antibiotics. 39 Samore et al 26 reported a decrease of 9 antibiotic prescriptions per 100 person-years using a clinical decision support system in combination with a community intervention in 12 rural communities. The current trial is unique for its exclusive focus on prescribing for children, the number of nonoverlapping communities (both urban and suburban) randomized, and the ability to compare effects among Medicaid and commercially insured children.…”

Section: Discussionmentioning

confidence: 99%

Impact of a 16-Community Trial to Promote Judicious Antibiotic Use in Massachusetts

et al. 2008

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OBJECTIVES. Reducing unnecessary antibiotic use, particularly among children, continues to be a public health priority. Previous intervention studies have been limited by size or design and have shown mixed results. The objective of this study was to determine the impact of a multifaceted, community-wide intervention on overall antibiotic use for young children and on use of broad-spectrum agents. In addition, we sought to compare the intervention's impact on commercially and Medicaid-insured children. METHODS. We conducted a controlled, community-level, cluster-randomized trial in 16 nonoverlapping Massachusetts communities, studied from 1998 to 2003. During 3 years, we implemented a physician behavior-change strategy that included guideline dissemination, small-group education, frequent updates and educational materials, and prescribing feedback. Parents received educational materials by mail and in primary care practices, pharmacies, and child care settings. Using health-plan data, we measured changes in antibiotics dispensed per person-year of observation among children who were aged 3 to <72 months, resided in study communities, and were insured by a participating commercial health plan or Medicaid. RESULTS. The data include 223135 person-years of observation. Antibiotic-use rates at baseline were 2.8, 1.7, and 1.4 antibiotics per person-year among those aged 3 to <24, 24 to <48, and 48 to <72 months, respectively. We observed a substantial downward trend in antibiotic prescribing, even in the absence of intervention. The intervention had no additional effect among children aged 3 to <24 months but was responsible for a 4.2% decrease among those aged 24 to <48 months and a 6.7% decrease among those aged 48 to <72 months. The intervention effect was greater among Medicaid-insured children and for broad-spectrum agents. CONCLUSIONS. A sustained, multifaceted, community-level intervention was only modestly successful at decreasing overall antibiotic use beyond substantial secular trends. The more robust impact among Medicaid-insured children and for specific medication classes provides an argument for specific targeting of resources for patient and physician behavior change.

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“…9 The introduction of guidelines alone has not proven to be effective at reducing antibiotic use for conditions that are, mainly, viral. 10 There is now evidence that those who consume antibiotics are more likely to become infected by organisms resistant to that antibiotic in the weeks and months following their antibiotic course. 11 There are many external (non-clinical) factors that influence a GP's decision to prescribe antibiotics.…”

Section: Introductionmentioning

confidence: 99%

Influence of patient payment on antibiotic prescribing in Irish general practice: a cohort study

Murphy

Byrne²,

Bradley³

2011

Br J Gen Pract

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BackgroundAntibiotics are widely believed to be overused and misused. Approximately 80% of all prescriptions for antibiotics are written by GPs. There are many external factors that influence a GP's decision to prescribe, including patient pressure. Access to primary care services operates on a two-tier system in the Republic of Ireland: General Medical Service (GMS) card holders have free access to GPs and medications; and non-card holders (private patients) must pay a non-subsidised fee to visit their GP. AimTo ascertain whether there was a difference in antibiotic prescribing practice between those who pay a fee for their GP consultation and those who attend free of charge. Design and settingCohort study in Irish general practice. MethodAll GPs attending continuing medical education (CME) groups nationwide were invited to participate from October 2008 until April 2010. GPs gathered data on 100 consecutive consultations including diagnosis and patient characteristics. ResultsData were collected from 171 GPs (distributed throughout Ireland), which resulted in 16 899 consultations. Antibiotics were prescribed at 3407 (20.16%) consultations. Nearly half of the prescriptions were for GMS card holders (n = 1669; 48.99%) and 1526 (44.79%) were for private patients; for 212 (6.22%) the payment status of the patient was unknown. Private patients were more likely to receive a prescription for antibiotics (odds ratio 1.23, 95% confidence interval = 1.14 to 1.33). ConclusionThese results demonstrate that a GP's decision to provide a prescription for antibiotics may be influenced by whether or not the patient pays for their consultation at the GP interface. Private patients are more likely than GMS card holders to receive a prescription for antibiotics.

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The Antimicrobial Treatment Strategies (MIKSTRA) Program: A 5-Year Follow-Up of Infection-Specific Antibiotic Use in Primary Health Care and the Effect of Implementation of Treatment Guidelines

Cited by 52 publications

References 27 publications

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

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

Impact of a 16-Community Trial to Promote Judicious Antibiotic Use in Massachusetts

Influence of patient payment on antibiotic prescribing in Irish general practice: a cohort study

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