title: Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial.
abstract: BACKGROUND
  High-volume prescribing of antibiotics in primary care is a major driver of antibiotic resistance. Education of physicians and patients can lower prescribing levels, but it frequently relies on highly trained staff. We assessed whether internet-based training methods could alter prescribing practices in multiple health-care systems.
  
  
  METHODS
  After a baseline audit in October to December, 2010, primary-care practices in six European countries were cluster randomised to usual care, training in the use of a C-reactive protein (CRP) test at point of care, in enhanced communication skills, or in both CRP and enhanced communication. Patients were recruited from February to May, 2011. This trial is registered, number ISRCTN99871214.
  
  
  RESULTS
  The baseline audit, done in 259 practices, provided data for 6771 patients with lower-respiratory-tract infections (3742 [55·3%]) and upper-respiratory-tract infections (1416 [20·9%]), of whom 5355 (79·1%) were prescribed antibiotics. After randomisation, 246 practices were included and 4264 patients were recruited. The antibiotic prescribing rate was lower with CRP training than without (33% vs 48%, adjusted risk ratio 0·54, 95% CI 0·42-0·69) and with enhanced-communication training than without (36% vs 45%, 0·69, 0·54-0·87). The combined intervention was associated with the greatest reduction in prescribing rate (CRP risk ratio 0·53, 95% CI 0·36-0·74, p<0·0001; enhanced communication 0·68, 0·50-0·89, p=0·003; combined 0·38, 0·25-0·55, p<0·0001).
  
  
  CONCLUSIONS
  Internet training achieved important reductions in antibiotic prescribing for respiratory-tract infections across language and cultural boundaries.
  
  
  BACKGROUND
  European Commission Framework Programme 6, National Institute for Health Research, Research Foundation Flanders.
authors.affiliation: Primary Care and Population Sciences Division, University of Southampton, Southampton, UK. p.little@soton.ac.uk
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.forename: Beth
authors.initials: B
authors.lastname: Stuart
authors.forename: Nick
authors.initials: N
authors.lastname: Francis
authors.forename: Elaine
authors.initials: E
authors.lastname: Douglas
authors.forename: Sarah
authors.initials: S
authors.lastname: Tonkin-Crine
authors.forename: Sibyl
authors.initials: S
authors.lastname: Anthierens
authors.forename: Jochen W L
authors.initials: JW
authors.lastname: Cals
authors.forename: Hasse
authors.initials: H
authors.lastname: Melbye
authors.forename: Miriam
authors.initials: M
authors.lastname: Santer
authors.forename: Michael
authors.initials: M
authors.lastname: Moore
authors.forename: Samuel
authors.initials: S
authors.lastname: Coenen
authors.forename: Chris
authors.initials: C
authors.lastname: Butler
authors.forename: Kerenza
authors.initials: K
authors.lastname: Hood
authors.forename: Mark
authors.initials: M
authors.lastname: Kelly
authors.forename: Maciek
authors.initials: M
authors.lastname: Godycki-Cwirko
authors.forename: Artur
authors.initials: A
authors.lastname: Mierzecki
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
authors.forename: Carl
authors.initials: C
authors.lastname: Llor
authors.forename: Melanie
authors.initials: M
authors.lastname: Davies
authors.forename: Mark
authors.initials: M
authors.lastname: Mullee
authors.forename: Gilly
authors.initials: G
authors.lastname: O'Reilly
authors.forename: Alike
authors.initials: A
authors.lastname: van der Velden
authors.forename: Adam W A
authors.initials: AW
authors.lastname: Geraghty
authors.forename: Herman
authors.initials: H
authors.lastname: Goossens
authors.forename: Theo
authors.initials: T
authors.lastname: Verheij
authors.forename: Lucy
authors.initials: L
authors.lastname: Yardley
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D002983:Clinical Competence / Q000592:standards; D016000:Cluster Analysis; D003142:Communication; D005060:Europe; D005260:Female; D058006:General Practice / Q000193:education* / Q000592:standards; D006801:Humans; D007318:Inservice Training; D020407:Internet; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011320:Primary Health Care / Q000592:standards; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D013663:Teaching / Q000379:methods*
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein
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