title: Intervention with educational outreach at large scale to reduce antibiotics for respiratory tract infections: a controlled before and after study.
abstract: BACKGROUND
  A multiple intervention targeted to reduce antibiotic prescribing with an educational outreach programme had proven to be effective in a randomized controlled trial in 12 peer review groups, demonstrating 12% less prescriptions for respiratory tract infections.
  
  
  OBJECTIVE
  To assess the effectiveness of a multiple intervention in primary care at a large scale.
  
  
  METHODS
  A controlled before and after study in 2006 and 2007 was designed. Participants were from general practices within a geographically defined area in the middle region of The Netherlands. Participants were GPs in 141 practices in 25 peer review groups. A control group of GP practices from the same region, matched for type of practice and mean volume of antibiotic prescribing. The multiple intervention consisted of the following elements: (i) group education meeting and communication training; (ii) monitoring and feedback on prescribing behaviour; (iii) group education for GPs and pharmacists assistants and (iv) patient education material. The main outcome measures are as follows: (i) number of antibiotic prescriptions per 1000 patients per GP and (ii) number of second-choice antibiotics, obtained from claims data from the regional health insurance company. The associations between predictors and outcome measurements were assessed by means of a multiple regression analyses.
  
  
  RESULTS
  At baseline, the number of antibiotic prescriptions per 1000 patients was slightly higher in the intervention group than in the control group (184 versus 176). In 2007, the number of prescriptions had increased to 232 and 227, respectively, and not differed between intervention and control group.
  
  
  CONCLUSIONS
  The implementation of an already proven effective multiple intervention strategy at a larger scale showed no reduction of antibiotic prescription rates. The failure might be attributed to a less tight monitoring of intervention and audit. Inserting practical tools in the intervention might be more successful and should be studied.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center, PO Box 85500, Utrecht 3500 GA, The Netherlands. h.m.smeets@umcutrecht.nl
authors.forename: H M
authors.initials: HM
authors.lastname: Smeets
authors.forename: M M
authors.initials: MM
authors.lastname: Kuyvenhoven
authors.forename: A E
authors.initials: AE
authors.lastname: Akkerman
authors.forename: I
authors.initials: I
authors.lastname: Welschen
authors.forename: G P
authors.initials: GP
authors.lastname: Schouten
authors.forename: G A
authors.initials: GA
authors.lastname: van Essen
authors.forename: T J M
authors.initials: TJ
authors.lastname: Verheij
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010821:Physicians, Family / Q000193:education*; D011320:Primary Health Care; D012140:Respiratory Tract Diseases / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D000900:Anti-Bacterial Agents