Abstract
BackgroundUse of information campaigns and educational interventions directed to citizens and supported by physicians, aimed at promoting the appropriate use of medicines, have been evaluated by several studies with conflicting results. These interventions are potentially relevant, favouring the reduction of unnecessary use of medicines and related risks. Several studies have specifically evaluated the promotion of the appropriate use of antibiotics in adults and children, with variable results. A controlled study is proposed to evaluate the feasibility and effectiveness of a multifaceted intervention aimed at reducing antibiotic prescription by increasing awareness on risks of their unnecessary use.Methods/designInformation will be provided to citizens through several media (posters, local TV, radio and newspapers, video terminals, websites of Local Health Authorities). Brochures with information on expected benefits and risks of antibiotics will be also available, either with direct access in waiting rooms and pharmacies or handed out and mediated by doctors. Physicians and pharmacists will get specific data on local antibiotic resistance. A small group of representative doctors have also actively participated in defining the campaign key messages. A sample of general practitioners and paediatricians will be trained in patient counselling strategies.The information campaign will be implemented in two Provinces of Emilia-Romagna during the fall-winter season (November 2011-February 2012). Change in the overall prescribing rate of antibiotics (expressed as DDD per 1000 inhabitants/day) in the intervention area will be compared versus other areas in the same Region. Knowledge and attitudes of the general population will be evaluated through a phone and internet survey on a representative sample.DiscussionWhile the campaign messages will be mainly directed to the general population, doctors' prescribing will be assessed. The main rationale for this apparent discrepancy lies in the influence patients may have on physicians' prescribing behaviour (directly or indirectly) and in physicians' endorsement of the campaign goals, considering their participation in its design.This study could observe a reduction lower than 5% in the prescribing rate of antibiotics. Such a reduction would be of public health relevance and would determine average savings of almost twice as much as the campaign costs.
Highlights
Use of information campaigns and educational interventions directed to citizens and supported by physicians, aimed at promoting the appropriate use of medicines, have been evaluated by several studies with conflicting results
While the campaign messages will be mainly directed to the general population, doctors’ prescribing will be assessed
Within a wider project called ProBA project, in 2003 the Health Agency of the Emilia-Romagna Region carried out a survey on 633 paediatricians (453 working as family paediatricians and 180 working in hospitals) and 1388 parents, aimed at evaluating the main determinants of antibiotic prescriptions for children [18]. This survey showed that improving paediatricians’ and parents’ knowledge on benefits and risks of antibiotics, and suggesting that resistance is a problem at the community and at the individual level, may favour their more appropriate use. Starting from these considerations and from local and international experiences on educational campaigns, we propose a study to evaluate the feasibility and effectiveness of a multifaceted intervention on antibiotic prescription in the general population, aimed at reducing it by increasing awareness on risk of unnecessary use, reducing patients’ requests for unnecessary prescription
Summary
This study will explore the impact of a local multifaceted information campaign on antibiotics. The likely presence of a parallel national campaign implemented in the same period (as it was in 2009 and 2010, part of a European initiative) could theoretically weaken the potential impact of this intervention; on the other side, we would be more confident if any effect had to be shown and the added value of a local initiative, with the use of local media and especially the participation of physicians, would be further elucidated. As for ethical aspects, the information campaign will provide general, clear and carefully balanced messages explaining when antibiotics are necessary and risks of their unnecessary use. This information is expected to increase appropriate use of antibiotics and, health of the exposed population. Since doctors (in particular general practitioners) will have a fundamental role in mediating this information, the risk of its incorrect interpretation will be very limited
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