title: Effectiveness of physician-targeted interventions to improve antibiotic use for respiratory tract infections.
abstract: BACKGROUND
  Antibiotic use and concomitant resistance are increasing. Literature reviews do not unambiguously indicate which interventions are most effective in improving antibiotic prescribing practice.
  
  
  OBJECTIVE
  To assess the effectiveness of physician-targeted  interventions aiming to improve antibiotic prescribing for respiratory tract infections (RTIs) in primary care, and to identify intervention features mostly contributing to intervention success.
  
  
  METHODS
  Analysis of a set of physician-targeted interventions in  primary care.
  
  
  METHODS
  A literature search (1990-2009) for studies describing the effectiveness of interventions aiming to optimise antibiotic prescription for RTIs by primary care physicians. Intervention features were extracted and effectiveness sizes were calculated.  Association between intervention features and intervention success was analysed in multivariate regression analysis.
  
  
  RESULTS
  This study included 58 studies, describing 87 interventions of which 60% significantly improved antibiotic prescribing; interventions aiming to decrease  overall antibiotic prescription were more frequently effective than interventions aiming to increase first choice prescription. On average, antibiotic prescription was reduced by 11.6%, and first choice prescription increased by 9.6%. Multiple interventions containing at least 'educational  material for the physician' were most often effective. No significant added value was found for interventions containing patient-directed elements. Communication skills training and near-patient testing sorted the largest intervention effects.
  
  
  CONCLUSIONS
  This review  emphasises the importance of physician education in optimising antibiotic use. Further research should focus on how to provide physicians with the relevant knowledge and tools, and when to supplement education with additional intervention elements. Feasibility should be included in this process.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands. a.w.vandervelden@umcutrecht.nl
authors.forename: Alike W
authors.initials: AW
authors.lastname: van der Velden
authors.forename: Eefje J
authors.initials: EJ
authors.lastname: Pijpers
authors.forename: Marijke M
authors.initials: MM
authors.lastname: Kuyvenhoven
authors.forename: Sarah K G
authors.initials: SK
authors.lastname: Tonkin-Crine
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.forename: Theo J M
authors.initials: TJ
authors.lastname: Verheij
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004503:Education, Medical, Graduate; D004812:Epidemiologic Methods; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D058007:Physicians, Primary Care / Q000193:education*; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000592:standards; D012141:Respiratory Tract Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents