title: Interventions to improve adherence to first-line antibiotics in respiratory tract infections. The impact depends on the intensity of the intervention.
abstract: BACKGROUND
  Many interventions aimed at improving the quality of antibiotic prescribing have been investigated, but more knowledge is needed regarding the impact of different intensity interventions.
  
  
  OBJECTIVE
  To compare the effect of two interventions, a basic intervention (BI) and intensive intervention (II), aimed to improve the adherence to recommendations on first-line antibiotics in patients with respiratory tract infections (RTIs).
  
  
  METHODS
  General practitioners (GPs) from different regions of Spain were offered two different interventions on antibiotic prescribing. They registered all patients with RTIs during 15 days before (2008) and after (2009) the intervention. GPs in Catalonia were exposed to BI including prescriber feedback, clinical guidelines and training sessions focused on appropriate antibiotic prescribing. The other group of GPs was exposed to an II, which besides BI, also included training and access to point-of-care tests in practice.
  
  
  RESULTS
  The GPs registered 15 073 RTIs before the intervention and 12 760 RTIs after. The antibiotic prescribing rate reduced from 27.7% to 19.8%. Prescribing of first-choice antibiotics increased after the intervention in both groups. In the group of GPs following the BI, first-line antibiotics accounted for 23.8% of antibiotics before the intervention and 29.4% after (increase 5.6%, 95% confidence interval (CI): 1.2-10%), while in the group of GPs following the II these figures were 26.2% and 48.6% (increase 22.4%, 95% CI: 18.8-26%), respectively.
  
  
  CONCLUSIONS
  Multifaceted interventions targeting GPs can improve adherence to recommendations for first-line antibiotic prescribing in patients with RTI, with intensive interventions that include point-of-care testing being more effective.
authors.affiliation: Institute of Primary Care and Public Health, School of Medicine, Cardiff University , Cardiff , UK.
authors.forename: Carl
authors.initials: C
authors.lastname: Llor
authors.forename: María José
authors.initials: MJ
authors.lastname: Monedero
authors.forename: Guillermo
authors.initials: G
authors.lastname: García
authors.forename: Javier
authors.initials: J
authors.lastname: Arranz
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Cots
authors.forename: Lars
authors.initials: L
authors.lastname: Bjerrum
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002983:Clinical Competence; D005260:Female; D058005:General Practitioners / Q000193:education*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D013030:Spain
chemical_list: D000900:Anti-Bacterial Agents
keywords: Respiratory tract infections; antibiotics; guideline; intervention