Promotion of rational antibiotic use in Flemish general practice: implementation of a guideline for acute cough

Abstract

To promote rational antibiotic use for acute cough in Flemish general practice. A cluster randomised controlled before and after study. 85 Flemish GPs, randomly assigned to control and intervention group recorded prescriptions, clinical and non-clinical information in 20 consecutive adult patients consulting with acute cough in the periods February-April 2000 and 2001. The intervention group received the Flemish guideline ‘acute cough’, one outreach visit (‘academic detailing’) focusing on the non-clinical information's influence on the prescribing decision and a postal reminder in January 2001. Differences in antibiotic prescribing rates were analysed using generalised estimating equations. 56 GPs (27 in the intervention, 29 in the control group) participated in both pre- and post-test, including 1503 patients eligible for analysis. Before the intervention the antibiotic prescription rate was 43% in the intervention and 38% in the control group, afterwards it was 27% and 29%, respectively. The reduction between 2000 and 2001 is significant in the intervention (P = 0.005) and the control group (P = 0.03), but no significant difference was found between intervention and control group in 2000 (P = 0.71), nor in 2001 (P = 0.27). Only the antibiotics prescribed by the intervention group in 2001 were more in line with the Flemish guideline (54%) compared to 2000 (40%, P = 0.06) (control group: 37% and 37%, resp., P = 0.84), thus saving on average 荤6 per patient. In 2001 significantly less antibiotics were prescribed for patients included before March 2001 in the intervention group (22%) compared to the control group (31%, P = 0.02) and compared to 2000 (43%, P = 0.002). There is a short term net effect of our intervention. The antibiotics prescribed by the intervention group correspond better with the Flemish guideline. Patient outcomes will be discussed on IPCRG 2002.