Reducing antibiotic prescriptions for respiratory tract infections in family practice: results of a cluster randomized controlled trial evaluating a multifaceted peer-group-based intervention.

Marcia Vervloet,Lucas S Van Der Hoek,Marianne A Meulepas,Liset Van Dijk,Jochen W L Cals,Mariëtta Eimers

doi:10.1038/npjpcrm.2015.83

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.

Highlights

Antibiotic resistance is a major public health problem.[1,2,3] A major risk factor is irrational antibiotic use, e.g., in patients with common respiratory tract infections (RTI)
Four intervention PharmacoTherapy Audit Meetings (PTAM) groups with 39 family physician (FP) and 4 matched control PTAM groups with 38 FPs participated in the study
The number of prescriptions decreased in all intervention PTAM groups after the intervention

Summary

Introduction

Antibiotic resistance is a major public health problem.[1,2,3] A major risk factor is irrational antibiotic use, e.g., in patients with common respiratory tract infections (RTI). Limited evidence is found for the benefit of antibiotics in RTI.[4,5,6] patients presenting with. RTI symptoms are still often prescribed antibiotics in family practice.[7] family physicians (FPs) are aware that they tend to overprescribe,[8,9] non-clinical factors such as time pressure, perceived patients’ expectations and the desire to maintain good relationships are mentioned as drivers to prescribe antibiotics.[9,10]. FPs need skills to identify patients’ needs and to discuss elements of the treatment such as its natural course, the benefits and harms of antibiotic treatment and when to consult the FP.[13]

Objectives

Methods

Results

Conclusion