Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial

被引:302
作者
Little, Paul [1 ]
Stuart, Beth [1 ]
Francis, Nick [4 ]
Douglas, Elaine [2 ]
Tonkin-Crine, Sarah [1 ]
Anthierens, Sibyl [12 ,13 ]
Cals, Jochen W. L. [16 ]
Melbye, Hasse [17 ]
Santer, Miriam [1 ]
Moore, Michael [1 ]
Coenen, Samuel
Butler, Chris [4 ]
Hood, Kerenza [5 ]
Kelly, Mark [5 ]
Godycki-Cwirko, Maciek [6 ]
Mierzecki, Artur [7 ]
Torres, Antoni [9 ,10 ]
Llor, Carl [14 ,15 ]
Davies, Melanie [8 ]
Mullee, Mark [1 ]
O'Reilly, Gilly [1 ]
van der Velden, Alike [3 ]
Geraghty, Adam W. A. [1 ]
Goossens, Herman [11 ]
Verheij, Theo [3 ]
Yardley, Lucy [2 ]
机构
[1] Univ Southampton, Primary Care & Populat Sci Div, Southampton, Hants, England
[2] Univ Med Ctr Utrecht, CAHP, Fac Social & Human Sci, Utrecht, Netherlands
[3] Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands
[4] Cardiff Univ, Sch Med, Cochrane Inst Primary Care & Publ Hlth, Cardiff CF10 3AX, S Glam, Wales
[5] Cardiff Univ, Sch Med, South East Wales Trials Unit, Cardiff CF10 3AX, S Glam, Wales
[6] Med Univ Lodz, Dept Family & Community Med, Lodz, Poland
[7] Pomeranian Med Univ, Independent Lab Family Physician Educ, Szczecin, Poland
[8] Ely, Ely Bridge Surg, Cardiff, S Glam, Wales
[9] August Pi & Sunyer Univ Barcelona Ciber Enfermeda, Barcelona Insitut Invest Biomed, Hosp Clin, Pneumol Dept,Clin Inst Thorax, Barcelona, Spain
[10] Univ Antwerp, Ctr Gen Practice, B-2020 Antwerp, Belgium
[11] Univ Antwerp, Lab Med Microbiol, B-2020 Antwerp, Belgium
[12] Univ Antwerp, Vaccine & Infect Dis Inst VAXINFECTIO, B-2020 Antwerp, Belgium
[13] Univ Antwerp, Dept Microbiol, B-2020 Antwerp, Belgium
[14] Univ Rovira & Virgili, E-43007 Tarragona, Spain
[15] Spanish Soc Family Med, Barcelona, Spain
[16] Maastricht Univ, CAPHRI, Maastricht, Netherlands
[17] Univ Tromso, Gen Practice Res Unit, Tromso, Norway
基金
美国国家卫生研究院;
关键词
C-REACTIVE PROTEIN; PRIMARY-CARE; ACUTE COUGH; GENERAL-PRACTICE; INTERVENTION; STRATEGIES; PNEUMONIA; COUNTRIES; DATABASE; COHORT;
D O I
10.1016/S0140-6736(13)60994-0
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background High-volume prescribing of antibiotics in primary care is a major driver of antibiotic resistance. Education of physicians and patients can lower prescribing levels, but it frequently relies on highly trained staff. We assessed whether internet-based training methods could alter prescribing practices in multiple health-care systems. Methods After a baseline audit in October to December, 2010, primary-care practices in six European countries were cluster randomised to usual care, training in the use of a C-reactive protein (CRP) test at point of care, in enhanced communication skills, or in both CRP and enhanced communication. Patients were recruited from February to May, 2011. This trial is registered, number ISRCTN99871214. Results The baseline audit, done in 259 practices, provided data for 6771 patients with lower-respiratory-tract infections (3742 [55.3%]) and upper-respiratory-tract infections (1416 [20.9%]), of whom 5355 (79.1%) were prescribed antibiotics. After randomisation, 246 practices were included and 4264 patients were recruited. The antibiotic prescribing rate was lower with CRP training than without (33% vs 48%, adjusted risk ratio 0.54, 95% CI 0.42-0.69) and with enhanced-communication training than without (36% vs 45%, 0.69, 0.54-0.87). The combined intervention was associated with the greatest reduction in prescribing rate (CRP risk ratio 0.53, 95% CI 0.36-0.74, p< 0.0001; enhanced communication 0.68, 0.50-0.89, p=0.003; combined 0.38, 0.25-0.55, p< 0.0001). Interpretation Internet training achieved important reductions in antibiotic prescribing for respiratory-tract infections across language and cultural boundaries.
引用
收藏
页码:1175 / 1182
页数:8
相关论文
共 27 条
  • [1] Patterns of intra-cluster correlation from primary care research to inform study design and analysis
    Adams, G
    Gulliford, MC
    Ukoumunne, OC
    Eldridge, S
    Chinn, S
    Campbell, MJ
    [J]. JOURNAL OF CLINICAL EPIDEMIOLOGY, 2004, 57 (08) : 785 - 794
  • [2] Antibiotic prescribing for respiratory tract infections in Dutch primary care in relation to patient age and clinical entities
    Akkerman, AE
    van der Wouden, JC
    Kuyvenhoven, MM
    Dieleman, JP
    Verheij, TJM
    [J]. JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 2004, 54 (06) : 1116 - 1121
  • [3] General practitioners' views on the acceptability and applicability of a web-based intervention to reduce antibiotic prescribing for acute cough in multiple European countries: a qualitative study prior to a randomised trial
    Anthierens, Sibyl
    Tonkin-Crine, Sarah
    Douglas, Elaine
    Fernandez-Vandellos, Patricia
    Krawczyk, Jaroslaw
    Llor, Carl
    Cals, Jochen W. L.
    Francis, Nick A.
    Yardley, Lucy
    Coenen, Samuel
    Verheij, Theo
    Goossens, Herman
    Little, Paul
    [J]. BMC FAMILY PRACTICE, 2012, 13
  • [4] Arnold SR, 2005, COCHRANE DB SYST REV, V4
  • [5] Variation in antibiotic prescribing and its impact on recovery in patients with acute cough in primary care: prospective study in 13 countries
    Butler, C. C.
    Hood, K.
    Verheij, T.
    Little, P.
    Melbye, H.
    Nuttall, J.
    Statistician, M. J. Kelly
    Molstad, S.
    Godycki-Cwirko, M.
    Almirall, J.
    Torres, A.
    Gillespie, D.
    Rautakorpi, U.
    Coenen, S.
    Goossens, H.
    [J]. BRITISH MEDICAL JOURNAL, 2009, 338 : 1545
  • [6] Butler CC, 2012, BMJ-BRIT MED J, V344, DOI [10.1136/bmj.d8173, 10.1136/bmj.e682]
  • [7] Enhanced Communication Skills and C-reactive Protein Point-of-Care Testing for Respiratory Tract Infection: 3.5-year Follow-up of a Cluster Randomized Trial
    Cals, Jochen W. L.
    de Bock, Leon
    Beckers, Pieter-Jan H. W.
    Francis, Nick A.
    Hopstaken, Rogier M.
    Hood, Kerenza
    de Bont, Eefje G. P. M.
    Butler, Christopher C.
    Dinant, Geert-Jan
    [J]. ANNALS OF FAMILY MEDICINE, 2013, 11 (02) : 157 - 164
  • [8] Point-of-Care C-Reactive Protein Testing and Antibiotic Prescribing for Respiratory Tract Infections: A Randomized Controlled Trial
    Cals, Jochen W. L.
    Schot, Marjolein J. C.
    de Jong, Sanne A. M.
    Dinant, Geert-Jan
    Hopstaken, Rogier M.
    [J]. ANNALS OF FAMILY MEDICINE, 2010, 8 (02) : 124 - 133
  • [9] Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial
    Cals, Jochen W. L.
    Butler, Christopher C.
    Hopstaken, Rogier M.
    Hood, Kerenza
    Dinant, Geert-Jan
    [J]. BMJ-BRITISH MEDICAL JOURNAL, 2009, 338 : 1112 - 1115
  • [10] Coenen S, 2006, BRIT J GEN PRACT, V56, P183