Reducing antibiotic prescriptions for acute cough by motivating GPs to change their attitudes to communication and empowering patients: a cluster-randomized intervention study.
OBJECTIVE
Assessing the efficacy of an educational intervention that aimed to reduce unnecessary antibiotic prescriptions in primary care by motivating GPs to change their attitudes to communication and by empowering patients.


METHODS
One hundred and four GPs in North-Rhine/Westphalia-Lippe, Germany were cluster-randomized into intervention and control. GPs randomized to receive the intervention were visited by peers. The intervention strategy was focused on the communication within the encounter, not on sharing knowledge about antibiotic prescribing. Leaflets and posters were provided that aimed at patient empowerment, thus enabling patients to raise the topic of antibiotic prescriptions themselves.


RESULTS
Eighty-six GPs (83%) remained in the study at 6 weeks and 61 GPs (59%) at 12 months. Antibiotic prescription rates within the control group were 54.7% at baseline and 36.4% within the intervention group at baseline. Generalized estimating equation models were applied. Baseline imbalances and confounding variables were controlled by adjustment. After the intervention, the ORs for the prescription of an antibiotic dropped to 0.58 [95% CI: (0.43;0.78), P < 0.001] after 6 weeks and were 0.72 [95% CI: (0.54;0.97), P = 0.028] after 12 months in the intervention group. In the control group, the ORs rose to 1.52 [95% CI: (1.19;1.95), P = 0.001] after 6 weeks and were 1.31 [95% CI: (1.01;1.71), P = 0.044] after 12 months; these ORs correspond to an approximately 60% relative reduction in antibiotic prescription rates at 6 weeks and a persistent 40% relative reduction at 12 months.


CONCLUSIONS
An interventional strategy that focused on doctor-patient communication and patient empowerment is an effective concept to reduce antibiotic prescriptions in primary care.
Altiner
Attila
A
Department of General Practice, Heinrich-Heine-University Duesseldorf, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany. altiner@med.uni-duesseldorf.de
Brockmann
Silke
S
Sielk
Martin
M
Wilm
Stefan
S
Wegscheider
Karl
K
Abholz
Heinz-Harald
HH
D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D016000:Cluster Analysis; D003371:Cough / Q000188:drug therapy*; D003625:Data Collection; D003627:Data Interpretation, Statistical; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D018579:Patient Selection; D010565:Persuasive Communication; D010821:Physicians, Family; D018401:Sample Size; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents