title: Reducing antibiotic prescriptions for respiratory tract infections in family practice: results of a cluster randomized controlled trial evaluating a multifaceted peer-group-based intervention.
abstract: Irrational antibiotic use for respiratory tract infections (RTI) is a major driver of bacterial resistance. The aim of this study was to evaluate the effect of a multifaceted peer-group based intervention aiming to reduce RTI-related antibiotic prescriptions in family practice. This was a cluster randomized controlled trial with pre- and follow-up measurement. The intervention was implemented through PharmacoTherapy Audit Meetings (PTAM) in which family physicians (FPs) and pharmacists collaborate. Four PTAM groups received the intervention consisting of: (1) FP communication skills training, including communication about delayed prescribing; (2) implementation of antibiotic prescribing agreements in FPs' Electronic Prescribing Systems; (3) quarterly feedback figures for FPs. Four other PTAM groups were matched controls. Primary outcome measure was the number of RTI-related antibiotic prescriptions after the intervention, assessed with multilevel linear regression analyses. Total number and number of prescriptions stratified by age (under/over 12 years) were analysed. At baseline, the average total number of RTI-related antibiotic prescriptions per 1,000 patients was 207.9 and 176.7 in the intervention and control PTAM groups, respectively. At follow-up, FPs in both the intervention and control groups prescribed significantly less antibiotics. For adolescents and adults, the drop in number of antibiotic prescription was significantly larger in the intervention groups (-27.8 per 1,000 patients) than the control groups (-7.2 per 1,000 patients; P<0.05). This multifaceted peer-group-based intervention was effective in reducing the number of RTI-related antibiotic prescriptions for adolescents and adults. To affect antibiotic prescribing in children other methods are needed.
authors: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors: Marcia
authors: M
authors: Vervloet
authors: Dutch Institute for Rational Use of Medicine, Utrecht, The Netherlands.|Meetpunt Kwaliteit, Eindhoven, The Netherlands.
authors: Marianne A
authors: MA
authors: Meulepas
authors: Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors: Jochen W L
authors: JW
authors: Cals
authors: Dutch Institute for Rational Use of Medicine, Utrecht, The Netherlands.
authors: Mariëtta
authors: M
authors: Eimers
authors: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors: Lucas S
authors: LS
authors: van der Hoek
authors: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors: Liset
authors: L
authors: van Dijk
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003142:Communication; D005194:Family Practice / Q000193:education*; D000068156:Formative Feedback; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D016014:Linear Models; D055361:Multilevel Analysis; D010353:Patient Education as Topic; D010379:Peer Group; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D012141:Respiratory Tract Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents