title: Reducing general practice trainees' antibiotic prescribing for respiratory tract infections: an evaluation of a combined face-to-face workshop and online educational intervention.
abstract: Over-prescription of antibiotics for non-pneumonia respiratory tract infections (RTIs) is a major concern in general practice. Australian general practice registrars (trainees) have inappropriately high rates of prescription of antibiotics for RTIs. The 'apprenticeship' educational model and the trainee-trainer relationship are drivers of this inappropriate prescribing. We aimed to reduce registrars' non-pneumonia RTI antibiotic prescribing via an educational intervention (a 90-min face-to-face workshop supported by online modules), complemented by delivery of the same intervention, separately, to their trainers. We conducted a pre- and post-intervention comparison of the registrars' intention to prescribe antibiotics for common RTIs using McNemar's test. We similarly tested changes in supervisors' intended prescribing. Prescribing intentions were elicited by responses to six written clinical vignettes (upper respiratory tract infection, otitis media, sore throat and three acute bronchitis vignettes). We found that, for registrars, there were statistically significant reductions in antibiotic prescribing for the sore throat (24.0% absolute reduction), otitis media (17.5% absolute reduction) and two of the three acute bronchitis (12.0% and 18.0% absolute reduction) vignettes. There were significant reductions in supervisors' antibiotic prescribing intentions for the same four vignettes. We conclude that our intervention produced a significant change in registrars' intention to prescribe antibiotics for non-pneumonia RTIs.
authors.affiliation: a General Practice Training Valley to Coast , Newcastle , Australia.|b School of Medicine and Public Health , University of Newcastle , Newcastle , Australia.
authors.forename: Parker J
authors.initials: PJ
authors.lastname: Magin
authors.affiliation: a General Practice Training Valley to Coast , Newcastle , Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Morgan
authors.affiliation: a General Practice Training Valley to Coast , Newcastle , Australia.
authors.forename: Amanda
authors.initials: A
authors.lastname: Tapley
authors.affiliation: b School of Medicine and Public Health , University of Newcastle , Newcastle , Australia.|c Menzies School of Health Research , Darwin , Australia.|d Department of Immunology and Infectious Diseases , John Hunter Hospital , Newcastle , Australia.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Davis
authors.affiliation: e Adelaide to Outback General Practice Training , Adelaide , Australia.
authors.forename: Lawrie
authors.initials: L
authors.lastname: McArthur
authors.affiliation: a General Practice Training Valley to Coast , Newcastle , Australia.
authors.forename: Kim M
authors.initials: KM
authors.lastname: Henderson
authors.affiliation: a General Practice Training Valley to Coast , Newcastle , Australia.
authors.forename: Katie J
authors.initials: KJ
authors.lastname: Mulquiney
authors.affiliation: f Discipline of General Practice , University of Notre Dame , Sydney , Australia.
authors.forename: Anthea
authors.initials: A
authors.lastname: Dallas
authors.affiliation: b School of Medicine and Public Health , University of Newcastle , Newcastle , Australia.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Davey
authors.affiliation: a General Practice Training Valley to Coast , Newcastle , Australia.
authors.forename: John
authors.initials: J
authors.lastname: Scott
authors.affiliation: g Discipline of General Practice , University of Queensland , Brisbane , Australia.
authors.forename: Mieke L
authors.initials: ML
authors.lastname: van Driel
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001315:Australia; D001991:Bronchitis / Q000188:drug therapy; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D058006:General Practice / Q000193:education*; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D020407:Internet; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010033:Otitis Media / Q000188:drug therapy; D010612:Pharyngitis / Q000188:drug therapy; D012141:Respiratory Tract Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibacterial agents; bronchitis; education; family practice; graduate; medical; physician prescribing patterns; respiratory tract infections