Effect of educational outreach on general practice prescribing of antibiotics and antidepressants: a two-year randomised controlled trial.
OBJECTIVE
Prescribing of broad spectrum antibiotics and antidepressants in general practice often does not accord with guidelines. The aim was to determine the effectiveness of educational outreach in improving the prescribing of selected antibiotics and antidepressants, and whether the effect is sustained for two years.


METHODS
Single blind randomized trial.


METHODS
Twenty-eight general practices in Leicestershire, England.


METHODS
Educational outreach visits were undertaken, tailored to barriers to change, 14 practices receiving visits for reducing selected antibiotics and 14 for improving antidepressant prescribing.


METHODS
Number of items prescribed per 1000 registered patients for amoxicillin with clavulanic acid (co-amoxiclav) and quinolone antibiotics, and average daily quantities per 1000 patients for lofepramine and fluoxetine antidepressants, measured at the practice level for six-month periods over two years.


RESULTS
There was no effect on the prescribing of co-amoxiclav, quinolones, or fluoxetine, but prescribing of lofepramine increased in accordance with the guidelines. The increase persisted throughout two years of follow-up.


CONCLUSIONS
A simple, group-level educational outreach intervention, designed to take account of identified barriers to change, can have a modest but sustained effect on prescribing levels. However, outreach is not always effective. The context in which change in prescribing practice is being sought, the views of prescribers concerning the value of the drug, or other unrecognised barriers to change may influence the effectiveness of outreach.
Enriquez-Puga
Andres
A
Department of Health Sciences, University of Leicester, Australia.
Baker
Richard
R
Paul
Sanjoy
S
Villoro-Valdes
Renata
R
D000328:Adult; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D018687:Antidepressive Agents, Second-Generation / Q000008:administration & dosage*; D000929:Antidepressive Agents, Tricyclic / Q000008:administration & dosage*; D002648:Child; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004502:Education, Medical, Continuing / Q000379:methods; D005194:Family Practice; D005260:Female; D005473:Fluoxetine / Q000008:administration & dosage; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D008127:Lofepramine / Q000008:administration & dosage; D008297:Male; D017063:Outcome Assessment, Health Care; D010821:Physicians, Family / Q000193:education / Q000523:psychology; D010818:Practice Patterns, Physicians'; D015363:Quinolones / Q000008:administration & dosage; D016037:Single-Blind Method
D000900:Anti-Bacterial Agents; D018687:Antidepressive Agents, Second-Generation; D000929:Antidepressive Agents, Tricyclic; D015363:Quinolones; D005473:Fluoxetine; D019980:Amoxicillin-Potassium Clavulanate Combination; D008127:Lofepramine