Improving antibiotic prescribing quality by an intervention embedded in the primary care practice accreditation: the ARTI4 randomized trial.
OBJECTIVE
Antibiotic overprescribing is a significant problem. Multifaceted interventions improved antibiotic prescribing quality; their implementation and sustainability, however, have proved difficult. We analysed the effectiveness of an intervention embedded in the quality cycle of primary care practice accreditation on quantity and quality of antibiotic prescribing for respiratory tract and ear infections (RTIs).


METHODS
This was a pragmatic, cluster-randomized intervention trial in 88 Dutch primary care practices. The intervention (physician education and audit/feedback on antibiotic prescribing quantity and quality) was integrated in practice accreditation by defining an improvement plan with respect to antibiotic prescribing for RTIs. Numbers and types of dispensed antibiotics were analysed from 1 year prior to the intervention to 2 years after the intervention (pharmacy data). Overprescribing, underprescribing and non-first-choice prescribing for RTIs were analysed at baseline and 1 year later (self-registration).


RESULTS
There were significant differences between intervention and control practices in the changes in dispensed antibiotics/1000 registered patients (first year: -7.6% versus -0.4%, P = 0.002; second year: -4.3% versus +2%, P = 0.015), which was more pronounced for macrolides and amoxicillin/clavulanate (first year: -12.7% versus +2.9%, P = 0.001; second year: -7.8% versus +6.7%, P = 0.005). Overprescribing for RTIs decreased from 44% of prescriptions to 28% (P < 0.001). Most general practitioners (GPs) envisaged practice accreditation as a tool for guideline implementation.


CONCLUSIONS
GP education and an audited improvement plan around antibiotics for RTIs as part of primary care practice accreditation sustainably improved antibiotic prescribing. Tools should be sought to further integrate and facilitate education and audit/feedback in practice accreditation.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (STR 6.103), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands a.w.vandervelden@umcutrecht.nl.
Alike W
AW
van der Velden
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (STR 6.103), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
Marijke M
MM
Kuyvenhoven
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (STR 6.103), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
Theo J M
TJ
Verheij
D000068:Accreditation / Q000379:methods*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D011307:Drug Prescriptions / Q000592:standards*; D004358:Drug Therapy / Q000592:standards*; D005260:Female; D006291:Health Policy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011320:Primary Health Care / Q000379:methods*
D000900:Anti-Bacterial Agents