Changing the Antibiotic Prescribing of general practice registrars: the ChAP study protocol for a prospective controlled study of a multimodal educational intervention.
Australian General Practitioners (GPs) are generous prescribers of antibiotics, prompting concerns including increasing antimicrobial resistance in the community. Recent data show that GPs in vocational training have prescribing patterns comparable with the high prescribing rate of their established GP supervisors. Evidence-based guidelines consistently advise that antibiotics are not indicated for uncomplicated upper respiratory tract infections (URTI) and are rarely indicated for acute bronchitis. A number of interventions have been trialled to promote rational antibiotic prescribing by established GPs (with variable effectiveness), but the impact of such interventions in a training setting is unclear. We hypothesise that intervening while early-career GPs are still developing their practice patterns and prescribing habits will result in better adherence to evidence-based guidelines as manifested by lower antibiotic prescribing rates for URTIs and acute bronchitis.



The intervention consists of two online modules, a face-to-face workshop for GP trainees, a face-to-face workshop for their supervisors and encouragement for the trainee-supervisor dyad to include a case-based discussion of evidence-based antibiotic prescribing in their weekly one-on-one teaching meetings. We will use a non-randomised, non-equivalent control group design to assess the impact on antibiotic prescribing for acute upper respiratory infections and acute bronchitis by GP trainees in vocational training.



Early-career GPs who are still developing their clinical practice and prescribing habits are an underutilized target-group for interventions to curb the growth of antimicrobial resistance in the community. Interventions that are embedded into existing training programs or are linked to continuing professional development have potential to increase the impact of existing interventions at limited additional cost.



Australian New Zealand Clinical Trials Registry, ACTRN12614001209684 (registered 17/11/2014).
Discipline of General Practice, School of Medicine, the University of Queensland, L8 Health Sciences Building 16/910, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia. m.vandriel@uq.edu.au.
Mieke L
ML
van Driel
Elermore Vale General Practice, Shop 10-13, Croudace Rd, Elermore Vale, NSW, 2287, Australia.
Simon
S
Morgan
GP Synergy NSW & ACT Research and Evaluation Unit, 17 Bolton St, Newcastle, NSW, 2300, Australia.
Amanda
A
Tapley
Rural Clinical School, The University of Adelaide, 122 Frome Street, Adelaide, SA, 5005, Australia.
Lawrie
L
McArthur
School of Medicine and Public Health, University of Newcastle, Newbolds Building, Corner Frith andGavey Streets, Mayfield, NSW, 2304, Australia.
Patrick
P
McElduff
Department of Psychology, University of Southampton, Shakleton Building, Highfield, Southampton, SO17 1BJ, UK.
Lucy
L
Yardley
School of Medicine, University of Notre Dame Australia, 160 Oxford St, Darlinghurst, NSW, 2010, Australia.
Anthea
A
Dallas
Discipline of General Practice, School of Medicine, the University of Queensland, L8 Health Sciences Building 16/910, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia.
Laura
L
Deckx
GP Synergy NSW & ACT Research and Evaluation Unit, 17 Bolton St, Newcastle, NSW, 2300, Australia.
Katie
K
Mulquiney
School of Medicine and Public Health, University of Newcastle, Newbolds Building, Corner Frith andGavey Streets, Mayfield, NSW, 2304, Australia.|Department of Infectious Diseases, John Hunter Hospital, Lookout Rd, New Lambton Heights, NSW, 2305, Australia.|Global and Tropical Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT, 0811, Australia.
Joshua S
JS
Davis
Discipline of General Practice, School of Medicine and Public Health, University of Newcastle, Newbolds Building, Corner Frith and Gavey Streets, Mayfield, NSW, 2304, Australia.
Andrew
A
Davey
GP Synergy NSW & ACT Research and Evaluation Unit, 17 Bolton St, Newcastle, NSW, 2300, Australia.
Kim
K
Henderson
Primary Care and Population Sciences Division, University of Southampton, Aldermoor Health Centre, Aldermoor Close Southampton SO16 5ST, Southampton, UK.
Paul
P
Little
GP Synergy NSW & ACT Research and Evaluation Unit, 17 Bolton St, Newcastle, NSW, 2300, Australia.|Discipline of General Practice, School of Medicine and Public Health, University of Newcastle, Newbolds Building, Corner Frith and Gavey Streets, Mayfield, NSW, 2304, Australia.
Parker J
PJ
Magin
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001315:Australia; D001991:Bronchitis / Q000188:drug therapy; D004493:Education; D004503:Education, Medical, Graduate / Q000379:methods; D058006:General Practice / Q000193:education*; D019983:Guideline Adherence; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D020407:Internet; D008505:Medical Staff, Hospital / Q000193:education*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012107:Research Design; D012141:Respiratory Tract Infections / Q000188:drug therapy
D000900:Anti-Bacterial Agents
Antibacterial agents; Drug resistance; Evidence-based medicine; General practice; Graduate medical education; Physician prescribing patterns