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

被引:33
作者
Naughton, Corina [1 ]
Feely, John [2 ]
Bennett, Kathleen [2 ]
机构
[1] Univ Coll Dublin, UCD Sch Nursing Midwifery & Hlth Syst, Hlth Sci Ctr, Dublin 4, Ireland
[2] Trinity Coll Dublin, Dept Pharmacol & Therapeut, Dublin, Ireland
关键词
academic detailing; antibiotic; prescribing; primary care; INTERRUPTED TIME-SERIES; PRIMARY-CARE; IMPLEMENTATION; INTERVENTION; ASSOCIATION; PATTERNS; BEHAVIOR;
D O I
10.1111/j.1365-2753.2008.01099.x
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
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.
引用
收藏
页码:807 / 812
页数:6
相关论文
共 36 条
  • [11] Decreasing antibiotic use in ambulatory practice - Impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults
    Gonzales, R
    Steiner, JF
    Lum, A
    Barrett, PH
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1999, 281 (16): : 1512 - 1519
  • [12] Outpatient antibiotic use in Europe and association with resistance: a cross-national database study.
    Goossens, H
    Ferech, M
    Stichele, RV
    Elseviers, M
    [J]. LANCET, 2005, 365 (9459) : 579 - 587
  • [13] National campaigns to improve antibiotic use
    Goossens, H
    Guillemot, D
    Ferech, M
    Schlemmer, B
    Costers, M
    van Breda, M
    Baker, LJ
    Cars, O
    Davey, PG
    [J]. EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY, 2006, 62 (05) : 373 - 379
  • [14] Grimshaw J, 2006, J GEN INTERN MED, V21, pS14, DOI 10.1111/j.1525-1497.2006.00357.x
  • [15] Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost-consequences analysis
    Hogg, W
    Baskerville, N
    Lemelin, J
    [J]. BMC HEALTH SERVICES RESEARCH, 2005, 5 (1)
  • [16] Hux JE, 1999, CAN MED ASSOC J, V161, P388
  • [17] Modification of general practitioner prescribing of antibiotics by use of a therapeutics adviser (academic detailer)
    Ilett, KF
    Johnson, S
    Greenhill, G
    Mullen, L
    Brockis, J
    Golledge, CL
    Reid, DB
    [J]. BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, 2000, 49 (02) : 168 - +
  • [18] Can better prescribing turn the tide of resistance?
    Livermore, D
    [J]. NATURE REVIEWS MICROBIOLOGY, 2004, 2 (01) : 73 - 78
  • [19] Minimising antibiotic resistance
    Livermore, DM
    [J]. LANCET INFECTIOUS DISEASES, 2005, 5 (07) : 450 - 459
  • [20] When is it cost-effective to change the behavior of health professionals?
    Mason, J
    Freemantle, N
    Nazareth, I
    Eccles, M
    Haines, A
    Drummond, M
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2001, 286 (23): : 2988 - 2992