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

Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial
Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial
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
0140-6736
1175-1182
Little, P.
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Stuart, B.
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Francis, N.
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Douglas, E.
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Tonkin-Crine, S.
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Anthierens, S.
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Cals, J.W.
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Melbye, H.
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Santer, M.
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Moore, M.
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Coenen, S.
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Butler, C.
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Hood, K.
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Kelly, M.
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Godycki-Cwirko, M.
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Mierzecki, A.
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Torres, A.
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Llor, C.
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Davies, M.
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Mullee, M.
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O'Reilly, G.
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van der Velden, A.
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Geraghty, A.W.
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Goossens, H.
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Verheij, T.
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Yardley, L.
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on behalf of the GRACE consortium
Little, P.
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Stuart, B.
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Francis, N.
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Douglas, E.
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Tonkin-Crine, S.
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Anthierens, S.
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Cals, J.W.
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Melbye, H.
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Santer, M.
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Moore, M.
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Coenen, S.
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Butler, C.
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Hood, K.
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Kelly, M.
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Godycki-Cwirko, M.
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Mierzecki, A.
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Torres, A.
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Llor, C.
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Davies, M.
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Mullee, M.
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O'Reilly, G.
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van der Velden, A.
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Geraghty, A.W.
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Goossens, H.
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Verheij, T.
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Yardley, L.
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Little, P., Stuart, B., Francis, N., Douglas, E., Tonkin-Crine, S., Anthierens, S., Cals, J.W., Melbye, H., Santer, M., Moore, M., Coenen, S., Butler, C., Hood, K., Kelly, M., Godycki-Cwirko, M., Mierzecki, A., Torres, A., Llor, C., Davies, M., Mullee, M., O'Reilly, G., van der Velden, A., Geraghty, A.W., Goossens, H., Verheij, T. and Yardley, L. , on behalf of the GRACE consortium (2013) Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial. The Lancet, 382 (9899), 1175-1182. (doi:10.1016/S0140-6736(13)60994-0). (PMID:23915885)

Record type: Article

Abstract

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

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More information

e-pub ahead of print date: 31 July 2013
Published date: 5 October 2013
Organisations: Primary Care & Population Sciences, Psychology

Identifiers

Local EPrints ID: 356232
URI: https://eprints.soton.ac.uk/id/eprint/356232
ISSN: 0140-6736
PURE UUID: a9734a45-95ca-4dd0-8e89-27c18449843d
ORCID for M. Santer: ORCID iD orcid.org/0000-0001-7264-5260
ORCID for M. Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for L. Yardley: ORCID iD orcid.org/0000-0002-3853-883X

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Date deposited: 30 Aug 2013 13:53
Last modified: 17 Jul 2019 01:06

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Contributors

Author: P. Little
Author: B. Stuart
Author: N. Francis
Author: E. Douglas
Author: S. Tonkin-Crine
Author: S. Anthierens
Author: J.W. Cals
Author: H. Melbye
Author: M. Santer ORCID iD
Author: M. Moore ORCID iD
Author: S. Coenen
Author: C. Butler
Author: K. Hood
Author: M. Kelly
Author: M. Godycki-Cwirko
Author: A. Mierzecki
Author: A. Torres
Author: C. Llor
Author: M. Davies
Author: M. Mullee
Author: G. O'Reilly
Author: A. van der Velden
Author: A.W. Geraghty
Author: H. Goossens
Author: T. Verheij
Author: L. Yardley ORCID iD

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