title: A RCT evaluating the effectiveness and cost-effectiveness of academic detailing versus postal prescribing feedback in changing GP antibiotic prescribing.
abstract: 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.
authors.affiliation: UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland. corina.naughton@ucd.ie
authors.forename: Corina
authors.initials: C
authors.lastname: Naughton
authors.forename: John
authors.initials: J
authors.lastname: Feely
authors.forename: Kathleen
authors.initials: K
authors.lastname: Bennett
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents