title: Intervention to improve the quality of antimicrobial prescribing for urinary tract infection: a cluster randomized trial.
abstract: BACKGROUND
  Overuse of antimicrobial therapy in the community adds to the global spread of antimicrobial resistance, which is jeopardizing the treatment of common infections.
  
  
  METHODS
  We designed a cluster randomized complex intervention to improve antimicrobial prescribing for urinary tract infection in Irish general practice. During a 3-month baseline period, all practices received a workshop to promote consultation coding for urinary tract infections. Practices in intervention arms A and B received a second workshop with information on antimicrobial prescribing guidelines and a practice audit report (baseline data). Practices in intervention arm B received additional evidence on delayed prescribing of antimicrobials for suspected urinary tract infection. A reminder integrated into the patient management software suggested first-line treatment and, for practices in arm B, delayed prescribing. Over the 6-month intervention, practices in arms A and B received monthly audit reports of antimicrobial prescribing.
  
  
  RESULTS
  The proportion of antimicrobial prescribing according to guidelines for urinary tract infection increased in arms A and B relative to control (adjusted overall odds ratio [OR] 2.3, 95% confidence interval [CI] 1.7 to 3.2; arm A adjusted OR 2.7, 95% CI 1.8 to 4.1; arm B adjusted OR 2.0, 95% CI 1.3 to 3.0). An unintended increase in antimicrobial prescribing was observed in the intervention arms relative to control (arm A adjusted OR 2.2, 95% CI 1.2 to 4.0; arm B adjusted OR 1.4, 95% CI 0.9 to 2.1). Improvements in guideline-based prescribing were sustained at 5 months after the intervention.
  
  
  CONCLUSIONS
  A complex intervention, including audit reports and reminders, improved the quality of prescribing for urinary tract infection in Irish general practice.
  
  
  BACKGROUND
  ClinicalTrials.gov, no. NCT01913860.
authors.affiliation: Discipline of General Practice (Vellinga, Galvin, Duane, Callan, Murphy) and Discipline of Bacteriology (Vellinga, Cormican), School of Medicine, and JE Cairnes School of Business and Economics (Domegan), National University of Ireland, Galway, Ireland; Department of Pharmacology and Therapeutics (Bennett), Trinity College Dublin, Dublin, Ireland; Department of Medical Microbiology (Cormican), University Hospital Galway, Galway, Ireland akke.vellinga@nuigalway.ie.
authors.forename: Akke
authors.initials: A
authors.lastname: Vellinga
authors.affiliation: Discipline of General Practice (Vellinga, Galvin, Duane, Callan, Murphy) and Discipline of Bacteriology (Vellinga, Cormican), School of Medicine, and JE Cairnes School of Business and Economics (Domegan), National University of Ireland, Galway, Ireland; Department of Pharmacology and Therapeutics (Bennett), Trinity College Dublin, Dublin, Ireland; Department of Medical Microbiology (Cormican), University Hospital Galway, Galway, Ireland.
authors.forename: Sandra
authors.initials: S
authors.lastname: Galvin
authors.affiliation: Discipline of General Practice (Vellinga, Galvin, Duane, Callan, Murphy) and Discipline of Bacteriology (Vellinga, Cormican), School of Medicine, and JE Cairnes School of Business and Economics (Domegan), National University of Ireland, Galway, Ireland; Department of Pharmacology and Therapeutics (Bennett), Trinity College Dublin, Dublin, Ireland; Department of Medical Microbiology (Cormican), University Hospital Galway, Galway, Ireland.
authors.forename: Sinead
authors.initials: S
authors.lastname: Duane
authors.affiliation: Discipline of General Practice (Vellinga, Galvin, Duane, Callan, Murphy) and Discipline of Bacteriology (Vellinga, Cormican), School of Medicine, and JE Cairnes School of Business and Economics (Domegan), National University of Ireland, Galway, Ireland; Department of Pharmacology and Therapeutics (Bennett), Trinity College Dublin, Dublin, Ireland; Department of Medical Microbiology (Cormican), University Hospital Galway, Galway, Ireland.
authors.forename: Aoife
authors.initials: A
authors.lastname: Callan
authors.affiliation: Discipline of General Practice (Vellinga, Galvin, Duane, Callan, Murphy) and Discipline of Bacteriology (Vellinga, Cormican), School of Medicine, and JE Cairnes School of Business and Economics (Domegan), National University of Ireland, Galway, Ireland; Department of Pharmacology and Therapeutics (Bennett), Trinity College Dublin, Dublin, Ireland; Department of Medical Microbiology (Cormican), University Hospital Galway, Galway, Ireland.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Bennett
authors.affiliation: Discipline of General Practice (Vellinga, Galvin, Duane, Callan, Murphy) and Discipline of Bacteriology (Vellinga, Cormican), School of Medicine, and JE Cairnes School of Business and Economics (Domegan), National University of Ireland, Galway, Ireland; Department of Pharmacology and Therapeutics (Bennett), Trinity College Dublin, Dublin, Ireland; Department of Medical Microbiology (Cormican), University Hospital Galway, Galway, Ireland.
authors.forename: Martin
authors.initials: M
authors.lastname: Cormican
authors.affiliation: Discipline of General Practice (Vellinga, Galvin, Duane, Callan, Murphy) and Discipline of Bacteriology (Vellinga, Cormican), School of Medicine, and JE Cairnes School of Business and Economics (Domegan), National University of Ireland, Galway, Ireland; Department of Pharmacology and Therapeutics (Bennett), Trinity College Dublin, Dublin, Ireland; Department of Medical Microbiology (Cormican), University Hospital Galway, Galway, Ireland.
authors.forename: Christine
authors.initials: C
authors.lastname: Domegan
authors.affiliation: Discipline of General Practice (Vellinga, Galvin, Duane, Callan, Murphy) and Discipline of Bacteriology (Vellinga, Cormican), School of Medicine, and JE Cairnes School of Business and Economics (Domegan), National University of Ireland, Galway, Ireland; Department of Pharmacology and Therapeutics (Bennett), Trinity College Dublin, Dublin, Ireland; Department of Medical Microbiology (Cormican), University Hospital Galway, Galway, Ireland.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Murphy
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D005260:Female; D058006:General Practice / Q000592:standards* / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control* / Q000706:statistics & numerical data; D007494:Ireland; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D017010:Reminder Systems; D014552:Urinary Tract Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents