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

Department of General Practice/Family Medicine, Institute of Health and Society, University of Oslo, P O Box 1130, Blindern, N-0318 Oslo, Norway.
BMJ (online) (Impact Factor: 16.38). 07/2013; 347:f4403. DOI: 10.1136/bmj.f4403
Source: PubMed

ABSTRACT 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.
Cluster randomised controlled study.
Existing continuing medical education groups were recruited and randomised to intervention or control.
79 groups, comprising 382 general practitioners, completed the interventions and data extractions.
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.
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.
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.
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.
Clinical trials NCT00272155.

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Available from: Morten Lindbæk, Mar 12, 2014
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    • "We identified 28 RCT studies containing clinician education. Most studies showed that reduction in antibiotic prescribing was achieved through interventions focused on clinician education programs, such as interactive seminars [14], mailing campaigns [15] [16], small-group education focusing on evidence-based medicine and communication skills [17] [18] [19], educational outreach visit [20] [21] [22] [23] [24], guidelines and leaflets [25] [26] [27] [28] [29] [30], and a combination of these educational strategies [31] [32]. On average, antibiotic prescription of the intervention group was reduced by 34.1% (from 9% to 52%) compared with the control group. "
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