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

• Published in: NPJ primary care respiratory medicine Vol. 26; no. 1; p. 15083
• Main Authors: Vervloet, Marcia, Meulepas, Marianne A, Cals, Jochen W L, Eimers, Mariëtta, van der Hoek, Lucas S, van Dijk, Liset
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 04.02.2016; Nature Publishing Group
• Subjects: 631/326/41/1969/2038; 692/308/2779/777; 692/699/1785; 692/700/565/1436; Anti-Bacterial Agents - therapeutic use; Communication; Family Practice - education; Formative Feedback; Humans; Inappropriate Prescribing - prevention & control; Internal Medicine; Linear Models; Medicine; Medicine & Public Health; Multilevel Analysis; Patient Education as Topic; Peer Group; Physician-Patient Relations; Pneumology/Respiratory System; Practice Patterns, Physicians; Primary Care Medicine; Respiratory Tract Infections - drug therapy; Thoracic Surgery
• ISSN: 2055-1010; 2055-1010
• DOI: 10.1038/npjpcrm.2015.83

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. Peer support helps doctors reduce antibiotic prescriptions Communications training and peer support help reduce the amount of antibiotics doctors prescribe for respiratory tract infections. Liset van Dijk from the Netherlands Institute for Health Services Research, Utrecht, and colleagues studied how meetings between primary care doctors and pharmacists designed to improve prescribing behavior could help reduce overprescription of antibiotics. Doctors were given training to help them communicate better about antibiotics with their patients, and feedback at quarterly meetings. Better prescribing practices were built in to their electronic prescribing systems. Doctors who received this support significantly reduced the amount of antibiotics they prescribed for common respiratory tract infections to patients over the age of 12, compared with the control group. The intervention did not affect prescriptions for children, a finding that the group wishes to study further.