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Evaluation of a web-based intervention to reduce antibiotic prescribing for LRTI in six European countries: quantitative process analysis of the GRACE/INTRO randomised controlled trial

Evaluation of a web-based intervention to reduce antibiotic prescribing for LRTI in six European countries: quantitative process analysis of the GRACE/INTRO randomised controlled trial
Evaluation of a web-based intervention to reduce antibiotic prescribing for LRTI in six European countries: quantitative process analysis of the GRACE/INTRO randomised controlled trial
Background

To reduce the spread of antibiotic resistance, there is a pressing need for worldwide implementation of effective interventions to promote more prudent prescribing of antibiotics for acute LRTI. This study is a process analysis of the GRACE/INTRO trial of a multifactorial intervention that reduced antibiotic prescribing for acute LRTI in six European countries. The aim was to understand how the interventions were implemented and to examine effects of the interventions on general practitioners’ (GPs’) and patients’ attitudes.

Methods

GPs were cluster randomised to one of three intervention groups or a control group. The intervention groups received web-based training in either use of the C-reactive protein (CRP) test, communication skills and use of a patient booklet, or training in both. GP attitudes were measured before and after the intervention using constructs from the Theory of Planned Behaviour and a Website Satisfaction Questionnaire. Effects of the interventions on patients were assessed by a post-intervention questionnaire assessing patient enablement, satisfaction with the consultation, and beliefs about the risks and need for antibiotics.

Results

GPs in all countries and intervention groups had very positive perceptions of the intervention and the web-based training, and felt that taking part had helped them to reduce prescribing. All GPs perceived reducing prescribing as more important and less risky following the intervention, and GPs in the communication groups reported increased confidence to reduce prescribing. Patients in the communication groups who received the booklet reported the highest levels of enablement and satisfaction and had greater awareness that antibiotics could be unnecessary and harmful.

Conclusions

Our findings suggest that the interventions should be broadly acceptable to both GPs and patients, as well as feasible to roll out more widely across Europe. There are also some indications that they could help to engender changes in GP and patient attitudes that will be helpful in the longer-term, such as increased awareness of the potential disadvantages of antibiotics and increased confidence to manage LRTI without them. Given the positive effects of the booklet on patient beliefs and attitudes, it seems logical to extend the use of the patient booklet to all patients.
prescribing, antibiotics, resistance, questionnaires
1-10
Yardley, L.
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Douglas, E.
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Anthierens, S.
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Tonkin-Crine, S.
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O'Reilly, G.
f66a0310-7e33-4ca7-bb85-8e7a0e780a5d
Stuart, B.
ab5138db-f67f-4bc3-a424-0bf0220cfc92
Geraghty, A.W.
2c6549fe-9868-4806-b65a-21881c1930af
Arden-Close, E.
c1a6ff3d-6c3e-4355-b392-1963aed075d5
van der Velden, A.W.
1ad78cb7-b556-42fc-a530-aa2d6d53b758
Goosens, H.
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Verheij, T.J.
809e3576-51ad-48e2-9762-e5d1ab873728
Butler, C.C.
736f78ad-3e18-4c63-900f-c2249577b645
Francis, N.A.
041feacf-540c-49ae-b830-eda31920738b
Little, P.
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Yardley, L.
64be42c4-511d-484d-abaa-f8813452a22e
Douglas, E.
2f8b1b09-182b-40fa-a0ae-39854f85f216
Anthierens, S.
f237b5ac-203d-4ae0-b02c-a696e357614b
Tonkin-Crine, S.
65679835-9bdc-48b6-92f3-cc6322cccc4f
O'Reilly, G.
f66a0310-7e33-4ca7-bb85-8e7a0e780a5d
Stuart, B.
ab5138db-f67f-4bc3-a424-0bf0220cfc92
Geraghty, A.W.
2c6549fe-9868-4806-b65a-21881c1930af
Arden-Close, E.
c1a6ff3d-6c3e-4355-b392-1963aed075d5
van der Velden, A.W.
1ad78cb7-b556-42fc-a530-aa2d6d53b758
Goosens, H.
88f4e5e3-9237-4fc6-bbea-2ccf8b8cff93
Verheij, T.J.
809e3576-51ad-48e2-9762-e5d1ab873728
Butler, C.C.
736f78ad-3e18-4c63-900f-c2249577b645
Francis, N.A.
041feacf-540c-49ae-b830-eda31920738b
Little, P.
1bf2d1f7-200c-47a5-ab16-fe5a8756a777

Yardley, L., Douglas, E., Anthierens, S., Tonkin-Crine, S., O'Reilly, G., Stuart, B., Geraghty, A.W., Arden-Close, E., van der Velden, A.W., Goosens, H., Verheij, T.J., Butler, C.C., Francis, N.A. and Little, P. (2013) Evaluation of a web-based intervention to reduce antibiotic prescribing for LRTI in six European countries: quantitative process analysis of the GRACE/INTRO randomised controlled trial. Implementation Science, 8 (134), 1-10. (doi:10.1186/1748-5908-8-134). (PMID:24238118)

Record type: Article

Abstract

Background

To reduce the spread of antibiotic resistance, there is a pressing need for worldwide implementation of effective interventions to promote more prudent prescribing of antibiotics for acute LRTI. This study is a process analysis of the GRACE/INTRO trial of a multifactorial intervention that reduced antibiotic prescribing for acute LRTI in six European countries. The aim was to understand how the interventions were implemented and to examine effects of the interventions on general practitioners’ (GPs’) and patients’ attitudes.

Methods

GPs were cluster randomised to one of three intervention groups or a control group. The intervention groups received web-based training in either use of the C-reactive protein (CRP) test, communication skills and use of a patient booklet, or training in both. GP attitudes were measured before and after the intervention using constructs from the Theory of Planned Behaviour and a Website Satisfaction Questionnaire. Effects of the interventions on patients were assessed by a post-intervention questionnaire assessing patient enablement, satisfaction with the consultation, and beliefs about the risks and need for antibiotics.

Results

GPs in all countries and intervention groups had very positive perceptions of the intervention and the web-based training, and felt that taking part had helped them to reduce prescribing. All GPs perceived reducing prescribing as more important and less risky following the intervention, and GPs in the communication groups reported increased confidence to reduce prescribing. Patients in the communication groups who received the booklet reported the highest levels of enablement and satisfaction and had greater awareness that antibiotics could be unnecessary and harmful.

Conclusions

Our findings suggest that the interventions should be broadly acceptable to both GPs and patients, as well as feasible to roll out more widely across Europe. There are also some indications that they could help to engender changes in GP and patient attitudes that will be helpful in the longer-term, such as increased awareness of the potential disadvantages of antibiotics and increased confidence to manage LRTI without them. Given the positive effects of the booklet on patient beliefs and attitudes, it seems logical to extend the use of the patient booklet to all patients.

Text
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More information

Accepted/In Press date: 12 November 2013
Published date: 15 November 2013
Keywords: prescribing, antibiotics, resistance, questionnaires
Organisations: Primary Care & Population Sciences, Psychology

Identifiers

Local EPrints ID: 363480
URI: https://eprints.soton.ac.uk/id/eprint/363480
PURE UUID: f1f79b5d-3080-42f6-9388-1f7bdf66223f
ORCID for L. Yardley: ORCID iD orcid.org/0000-0002-3853-883X

Catalogue record

Date deposited: 25 Mar 2014 14:39
Last modified: 17 Jul 2019 01:06

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