title: Long-term effects of an educational seminar on antibiotic prescribing by GPs: a randomised controlled trial.
abstract: BACKGROUND
  High levels of outpatient antibiotic use remain observed in many European countries. Several studies have shown a strong relationship between antibiotic use and bacterial resistance.
  
  
  OBJECTIVE
  To assess the long-term effect of a standardised educational seminar on antibiotic prescriptions by GPs.
  
  
  METHODS
  Randomised controlled trial of 171 GPs (of 203 initially randomised) in France.
  
  
  METHODS
  GPs in the control group (n = 99) received no antibiotic prescription recommendation. Intervention group GPs (n = 72) attended an interactive seminar presenting evidence-based guidelines on antibiotic prescription for respiratory infections. The proportion of prescriptions containing an antibiotic in each group and related costs were compared to the baseline up to 30 months following the intervention. Data were obtained from the National Health Insurance System database.
  
  
  RESULTS
  In the intervention group, 4-6 months after the intervention, there was a significant decrease in the proportion of prescriptions containing an antibiotic from 15.2 ± 5.4% to 12.3 ± 5.8% (-2.8% [95% CI = -3.8 to -1.9], P<0.001). By contrast, an increase was observed in controls from 15.3 ± 6.0 to 16.4 ± 6.7% (+1.1% [95% CI = +0.4 to +1.8], P<0.01), resulting in a between-group difference of 3.93% ([95% CI = 2.75 to 5.11], P<0.001). The between-group difference was maintained 30 months after intervention (1.99% [95% CI = 0.56 to 3.42], P<0.01). Persistence of the intervention effect over the entire study period was confirmed in a hierarchical multivariate analysis.
  
  
  CONCLUSIONS
  This randomised trial shows that a standardised and interactive educational seminar results in a long-term reduction in antibiotic prescribing and could justify a large-scale implementation of this intervention.
authors.affiliation: INSERM, Clinical Investigation Centre 006, Créteil, France. philippe.lecorvoisier@hmn.aphp.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Le Corvoisier
authors.forename: Vincent
authors.initials: V
authors.lastname: Renard
authors.forename: Françoise
authors.initials: F
authors.lastname: Roudot-Thoraval
authors.forename: Thierry
authors.initials: T
authors.lastname: Cazalens
authors.forename: Kalaivani
authors.initials: K
authors.lastname: Veerabudun
authors.forename: Florence
authors.initials: F
authors.lastname: Canoui-Poitrine
authors.forename: Olivier
authors.initials: O
authors.lastname: Montagne
authors.forename: Claude
authors.initials: C
authors.lastname: Attali
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D011307:Drug Prescriptions / Q000592:standards / Q000706:statistics & numerical data; D004352:Drug Resistance, Microbial; D004502:Education, Medical, Continuing; D005260:Female; D005602:France / Q000453:epidemiology; D058006:General Practice / Q000706:statistics & numerical data*; D058005:General Practitioners / Q000706:statistics & numerical data*; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data*; D011446:Prospective Studies; D013995:Time
chemical_list: D000900:Anti-Bacterial Agents