A RCT evaluating the effectiveness and cost-effectiveness of academic detailing versus postal prescribing feedback in changing GP antibiotic prescribing

Purpose The aim of this study is to evaluate the effectiveness of academic detailing (AD) plus postal prescribing feedback versus postal prescribing feedback alone in reducing: (i) the overall rate of antibiotic; and (ii) proportion of second-line antibiotic prescribing. In addition, the cost-effectiveness of an outreach prescriber adviser service versus a postal prescribing feedback service was evaluated. Methods Volunteer general practitioner practices (n = 98) were randomized to receive prescribing feedback via postal bulletin (PB) (n = 50) or academic detailing plus postal bulletin (AD) (n = 48). Data analysis was based on the HSE-primary care reimbursement service (HSE-PCRS) prescribing database. Regression (beta) coefficients, indicating proportion change in prescribing per month, and 95% confidence intervals (CIs) are presented. The cost-effectiveness ratio was calculated from the total cost of the intervention divided by percentage change in antiobiotic prescribing in AD versus PB group. Results Immediately post intervention PB (beta = -0.02, 95% CI -0.04, -0.001) and AD (beta = -0.02, 95% CI -0.03, -0.001) practices significantly decreased overall antibiotic prescribing. Second-line antibiotic prescribing was also significantly decreased by 2-3% in both groups. However, there were no significant differences in antibiotic prescribing between the randomized groups in the immediate or long-term post-intervention period. In the cost-effectiveness analysis a postal prescribing feedback service would cost 88 per percentage change in prescribing practice compared with 778 for a prescriber adviser service. Conclusion Prescribing feedback significantly reduced overall and second-line antibiotic prescribing, but academic detailing was not significantly more effective than postal bulletin in changing antibiotic prescribing practice.