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Cluster randomised trial in the General Practice Research Database: 1. Electronic decision support to reduce antibiotic prescribing in primary care (eCRT study)

Cluster randomised trial in the General Practice Research Database: 1. Electronic decision support to reduce antibiotic prescribing in primary care (eCRT study)
Cluster randomised trial in the General Practice Research Database: 1. Electronic decision support to reduce antibiotic prescribing in primary care (eCRT study)
Background: the purpose of this research is to develop and evaluate methods for conducting cluster randomised trials in a primary care database that contains electronic patient records for large numbers of family practices. Cluster randomised trials are trials in which the units allocated represent groups of individuals, in this case family practices and their registered patients. Cluster randomised trials often suffer from the limitation that they include too few clusters, leading to problems of insufficient power and only imprecise estimation of the intraclass correlation coefficient, a key design parameter. This difficulty might be overcome by utilising databases that already hold electronic patient records for large numbers of practices. The protocol describes one application: a study of antibiotic prescribing for acute respiratory infection; a second protocol outlines an intervention in a less frequent chronic condition of public health importance, stroke.

Methods/Design: the objective of the study is to implement a cluster randomised trial to test the effectiveness of an electronic record-based intervention at achieving a reduction in antibiotic prescribing at consultations for respiratory illness in patients aged 18 and 59 years old in intervention family practices as compared with controls. Family practices will be recruited from the practices that presently contribute data to the UK General Practice Research Database (GPRD). Following randomisation, electronic prompts will be installed remotely at intervention practices to promote adherence with evidence-based standards of medical practice. The intervention was developed through qualitative research at non-intervention practices. Data for outcome assessment will be obtained from anonymised electronic patient records that are routinely collected into GPRD. This protocol outlines the proposed study designs, data sources, sample size requirements, analysis methods and dissemination plans. Ethical issues are also discussed.

Discussion: results from this study will provide methodological evidence concerning the use of electronic patient records and databases for implementing cluster randomised trials in primary care. The study will also provide substantive findings in respect of electronic record-based interventions to reduce antibiotic prescribing in primary care
1745-6215
1-6 [6pp]
Gulliford, Martin C.
5c557aa2-db12-43a2-8778-eac74cf42138
Van Staa, Tjeerd P.
3e33e405-5ea6-4196-9693-7258f7fba8cb
McDermott, Lisa
5e895229-decd-4a30-8d08-dd9cc5b8f443
Dregan, Alex
3e9f701f-54d9-4519-a7b7-e18e05b427c7
McCann, Gerard
d970a747-db34-4088-9fc5-63befb3479d3
Ashworth, Maek
796869d4-3c58-4750-80cc-dd0f03eb5081
Charlton, Judith
27682a6d-c126-45fb-a8a1-dbde57ccb4e9
Grieve, Andrew P.
b4f04118-cdbd-4599-a621-1f945f4bed60
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Electronic Cluster Randomised Trial Research Team eCRT Research Team
Gulliford, Martin C.
5c557aa2-db12-43a2-8778-eac74cf42138
Van Staa, Tjeerd P.
3e33e405-5ea6-4196-9693-7258f7fba8cb
McDermott, Lisa
5e895229-decd-4a30-8d08-dd9cc5b8f443
Dregan, Alex
3e9f701f-54d9-4519-a7b7-e18e05b427c7
McCann, Gerard
d970a747-db34-4088-9fc5-63befb3479d3
Ashworth, Maek
796869d4-3c58-4750-80cc-dd0f03eb5081
Charlton, Judith
27682a6d-c126-45fb-a8a1-dbde57ccb4e9
Grieve, Andrew P.
b4f04118-cdbd-4599-a621-1f945f4bed60
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e

Gulliford, Martin C., Van Staa, Tjeerd P., McDermott, Lisa, Dregan, Alex, McCann, Gerard, Ashworth, Maek, Charlton, Judith, Grieve, Andrew P., Little, Paul, Moore, Michael and Yardley, Lucy , Electronic Cluster Randomised Trial Research Team eCRT Research Team (2011) Cluster randomised trial in the General Practice Research Database: 1. Electronic decision support to reduce antibiotic prescribing in primary care (eCRT study). Trials, 12 (115), 1-6 [6pp]. (doi:10.1186/1745-6215-12-115). (PMID:21569237)

Record type: Article

Abstract

Background: the purpose of this research is to develop and evaluate methods for conducting cluster randomised trials in a primary care database that contains electronic patient records for large numbers of family practices. Cluster randomised trials are trials in which the units allocated represent groups of individuals, in this case family practices and their registered patients. Cluster randomised trials often suffer from the limitation that they include too few clusters, leading to problems of insufficient power and only imprecise estimation of the intraclass correlation coefficient, a key design parameter. This difficulty might be overcome by utilising databases that already hold electronic patient records for large numbers of practices. The protocol describes one application: a study of antibiotic prescribing for acute respiratory infection; a second protocol outlines an intervention in a less frequent chronic condition of public health importance, stroke.

Methods/Design: the objective of the study is to implement a cluster randomised trial to test the effectiveness of an electronic record-based intervention at achieving a reduction in antibiotic prescribing at consultations for respiratory illness in patients aged 18 and 59 years old in intervention family practices as compared with controls. Family practices will be recruited from the practices that presently contribute data to the UK General Practice Research Database (GPRD). Following randomisation, electronic prompts will be installed remotely at intervention practices to promote adherence with evidence-based standards of medical practice. The intervention was developed through qualitative research at non-intervention practices. Data for outcome assessment will be obtained from anonymised electronic patient records that are routinely collected into GPRD. This protocol outlines the proposed study designs, data sources, sample size requirements, analysis methods and dissemination plans. Ethical issues are also discussed.

Discussion: results from this study will provide methodological evidence concerning the use of electronic patient records and databases for implementing cluster randomised trials in primary care. The study will also provide substantive findings in respect of electronic record-based interventions to reduce antibiotic prescribing in primary care

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More information

Published date: May 2011
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 191573
URI: http://eprints.soton.ac.uk/id/eprint/191573
ISSN: 1745-6215
PURE UUID: 4434b4b0-4c11-4d46-9335-1f0251b20c65
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for Lucy Yardley: ORCID iD orcid.org/0000-0002-3853-883X

Catalogue record

Date deposited: 22 Jun 2011 10:33
Last modified: 26 Nov 2019 01:55

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