A RCT evaluating the effectiveness and cost-effectiveness of academic detailing versus postal prescribing feedback in changing GP antibiotic prescribing.
OBJECTIVE
The aim of this study is to evaluate the effectiveness of academic detailing (AD) plus postal prescribing feedback versus postal prescribing feedback alone in reducing: (i) the overall rate of antibiotic; and (ii) proportion of second-line antibiotic prescribing. In addition, the cost-effectiveness of an outreach prescriber adviser service versus a postal prescribing feedback service was evaluated.


METHODS
Volunteer general practitioner practices (n = 98) were randomized to receive prescribing feedback via postal bulletin (PB) (n = 50) or academic detailing plus postal bulletin (AD) (n = 48). Data analysis was based on the HSE-primary care reimbursement service (HSE-PCRS) prescribing database. Regression (beta) coefficients, indicating proportion change in prescribing per month, and 95% confidence intervals (CIs) are presented. The cost-effectiveness ratio was calculated from the total cost of the intervention divided by percentage change in antibiotic prescribing in AD versus PB group.


RESULTS
Immediately post intervention PB (beta = -0.02, 95% CI -0.04, -0.001) and AD (beta = -0.02, 95% CI -0.03, -0.001) practices significantly decreased overall antibiotic prescribing. Second-line antibiotic prescribing was also significantly decreased by 2-3% in both groups. However, there were no significant differences in antibiotic prescribing between the randomized groups in the immediate or long-term post-intervention period. In the cost-effectiveness analysis a postal prescribing feedback service would cost euro 88 per percentage change in prescribing practice compared with euro 778 for a prescriber adviser service.


CONCLUSIONS
Prescribing feedback significantly reduced overall and second-line antibiotic prescribing, but academic detailing was not significantly more effective than postal bulletin in changing antibiotic prescribing practice.
Naughton
Corina
C
UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland. corina.naughton@ucd.ie
Feely
John
J
Bennett
Kathleen
K
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D019992:Databases as Topic; D011307:Drug Prescriptions; D004352:Drug Resistance, Microbial; D005246:Feedback; D006801:Humans; D007494:Ireland; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects; D010821:Physicians, Family / Q000193:education*; D011177:Postal Service; D010818:Practice Patterns, Physicians'; D015397:Program Evaluation
D000900:Anti-Bacterial Agents