Optimizing antibiotic prescribing for acute cough in general practice: a cluster-randomized controlled trial.
OBJECTIVE
To assess the effect of a tailored professional intervention, including academic detailing, on antibiotic prescribing for acute cough.


METHODS
In a cluster-randomized controlled before and after study 85 Flemish GPs included adult patients with acute cough consulting in the periods February-April 2000 and 2001. The intervention consisted of a clinical practice guideline for acute cough, an educational outreach visit and a postal reminder to support its implementation in January 2001. Antibiotic prescribing rates and patients' symptom resolution were the main outcome measures.


RESULTS
Thirty-six of 42 GPs received the intervention and 35 of 43 GPs served as controls; 1503 patients were eligible for analysis. Only in the intervention group were patients less likely to receive antibiotics after the intervention [OR(adj) (95% CI)=0.56 (0.36-0.87)]. Prescribed antibiotics were also more in line with the guideline in the intervention group [1.90 (0.96-3.75)] and less expensive from the perspective of the National Sickness and Invalidity Insurance Institute [MD(adj) (95% CI)= Euro -6.89 [-11.77-(-2.02)]]. No significant differences were found between the groups for the time to symptom resolution.


CONCLUSIONS
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.
Centre for General Practice, University of Antwerp, BE 2610 Antwerp, Belgium. samuel.coenen@ua.ac.be
Samuel
S
Coenen
Paul
P
Van Royen
Barbara
B
Michiels
Joke
J
Denekens
D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D001530:Belgium / Q000453:epidemiology; D016000:Cluster Analysis; D003371:Cough / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D003625:Data Collection; D016527:Drug Costs; D011307:Drug Prescriptions; D005194:Family Practice; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D012307:Risk Factors; D018401:Sample Size; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents