Effectiveness of a multiple intervention to reduce antibiotic prescribing for respiratory tract symptoms in primary care: randomised controlled trial.
OBJECTIVE
To assess the effectiveness of a multiple intervention aimed at reducing antibiotic prescription rates for symptoms of the respiratory tract in primary care.


METHODS
Randomised controlled trial.


METHODS
Twelve peer review groups including 100 general practitioners with their collaborating pharmacists in the region of Utrecht, Netherlands.


METHODS
The intervention consisted of group education meetings, with a consensus procedure on indication for and type of antibiotics and with training in communication skills; monitoring and feedback on prescribing behaviour; group education for assistants of general practitioners and pharmacists; and education material for patients. The control group did not receive any of these elements.


METHODS
Antibiotic prescription rates for acute symptoms of the respiratory tract and patients' satisfaction.


RESULTS
89 general practitioners completed the study (89%). At baseline, prescription rates for antibiotics for respiratory tract symptoms did not differ between intervention and control group (27% v 29%, respectively). After nine months, the prescription rates in the intervention group fell to 23%, whereas the control group's rose to 37% (mean difference in change -12%, 95% confidence interval -18.9% to -4.0%). Multilevel analysis confirmed the results of the unadjusted analysis (intervention effect -10.7%, -20.3% to -1.0%). Patients' satisfaction was high and did not differ in the two groups at baseline or after the intervention.


CONCLUSIONS
A multiple intervention reduced prescribing rates of antibiotics for respiratory tract symptoms while maintaining a high degree of satisfaction among patients. Further research should focus on the sustainability and cost effectiveness of this intervention.
Welschen
Ineke
I
University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, PO Box 85060, 3508 AB Utrecht, Netherlands. i.welschen@med.uu.nl
Kuyvenhoven
Marijke M
MM
Hoes
Arno W
AW
Verheij
Theo J M
TJ
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands; D017060:Patient Satisfaction; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012141:Respiratory Tract Infections / Q000188:drug therapy*
D000900:Anti-Bacterial Agents