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Reducing early career general practitioners’ antibiotic prescribing for respiratory tract infections: a pragmatic prospective non-randomised controlled trial

Reducing early career general practitioners’ antibiotic prescribing for respiratory tract infections: a pragmatic prospective non-randomised controlled trial
Reducing early career general practitioners’ antibiotic prescribing for respiratory tract infections: a pragmatic prospective non-randomised controlled trial
Background
Inappropriate antibiotic prescription and consequent antibacterial resistance is a major threat to healthcare.

Objectives
To evaluate the efficacy of a multifaceted intervention in reducing early career general practitioners’ (GPs’) antibiotic prescribing for upper respiratory tract infections (URTIs) and acute bronchitis/bronchiolitis.

Methods
A pragmatic non-randomized trial employing a non-equivalent control group design nested within an existing cohort study of GP registrars’ (trainees’) clinical practice. The intervention included access to online modules (covering the rationale of current clinical guidelines recommending non-prescription of antibiotics for URTI and bronchitis/bronchiolitis, and communication skills in management of acute bronchitis) followed by a face-to-face educational session. The intervention was delivered to registrars (and their supervisors) in two of Australia’s seventeen regional GP training providers (RTPs). Three other RTPs were the control group. Outcomes were proportion of registrars’ URTI consultations and bronchitis/bronchiolitis consultations prescribed antibiotics. Intention-to-treat analyses employed logistic regression within a Generalised Estimating Equation framework, adjusted for relevant independent variables. The predictors of interest were time; treatment group; and an interaction term for time-by-treatment group. The P value associated with an interaction term determined statistically significant differences in antibiotic prescribing.

Results
Analyses include data of 217 intervention RTPs’ and 311 control RTPs’ registrars. There was no significant reduction in antibiotic prescribing for URTIs. For bronchitis/bronchiolitis, a significant reduction (interaction P value = 0.024) remained true for analysis adjusted for independent variables (P value = 0.040). The adjusted absolute reduction in prescribing was 15.8% (95% CI: 4.2%–27.5%).

Conclusions
A multifaceted intervention reduced antibiotic prescribing for bronchitis/bronchiolitis but not URTIs.
0263-2136
53–60
Magin, Parker J.
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Tapley, Amanda
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Morgan, Simon
67f928e6-256d-41ee-9367-bf8fa9ce2210
Davis, Joshua S.
a8e5bda3-8ccf-4b47-b188-ed3287a5c0f8
McElduff, Patrick
3ce072d7-03dc-4e90-a36a-c8e95d98cff4
Yardley, Lucy
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Henderson, Kim
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Dallas, Anthea
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McArthur, Lawrie
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Mulquiney, Katie
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Davey, Andrew
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Little, Paul
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Spike, Neil
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van Driel, Mieke L.
daeac878-0204-4bd3-8b06-5389a10c1ab0
Magin, Parker J.
3cdf4d46-2303-440c-a2a8-1b464925a17b
Tapley, Amanda
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Morgan, Simon
67f928e6-256d-41ee-9367-bf8fa9ce2210
Davis, Joshua S.
a8e5bda3-8ccf-4b47-b188-ed3287a5c0f8
McElduff, Patrick
3ce072d7-03dc-4e90-a36a-c8e95d98cff4
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Henderson, Kim
291554e2-5423-4a67-9eb8-a899d738de07
Dallas, Anthea
93d06d05-26c6-4c65-ad64-32348a3a6339
McArthur, Lawrie
3567f2e3-5860-4c84-846d-7780943985da
Mulquiney, Katie
6d5a5e14-f2e8-4f91-8765-af8327ef15fd
Davey, Andrew
86f3030f-9c68-4708-9fa0-508c5361cf98
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Spike, Neil
358916bf-ad76-43eb-a7dc-deda3ce5b20a
van Driel, Mieke L.
daeac878-0204-4bd3-8b06-5389a10c1ab0

Magin, Parker J., Tapley, Amanda, Morgan, Simon, Davis, Joshua S., McElduff, Patrick, Yardley, Lucy, Henderson, Kim, Dallas, Anthea, McArthur, Lawrie, Mulquiney, Katie, Davey, Andrew, Little, Paul, Spike, Neil and van Driel, Mieke L. (2018) Reducing early career general practitioners’ antibiotic prescribing for respiratory tract infections: a pragmatic prospective non-randomised controlled trial. Family Practice, 35 (1), 53–60, [cmx070]. (doi:10.1093/fampra/cmx070).

Record type: Article

Abstract

Background
Inappropriate antibiotic prescription and consequent antibacterial resistance is a major threat to healthcare.

Objectives
To evaluate the efficacy of a multifaceted intervention in reducing early career general practitioners’ (GPs’) antibiotic prescribing for upper respiratory tract infections (URTIs) and acute bronchitis/bronchiolitis.

Methods
A pragmatic non-randomized trial employing a non-equivalent control group design nested within an existing cohort study of GP registrars’ (trainees’) clinical practice. The intervention included access to online modules (covering the rationale of current clinical guidelines recommending non-prescription of antibiotics for URTI and bronchitis/bronchiolitis, and communication skills in management of acute bronchitis) followed by a face-to-face educational session. The intervention was delivered to registrars (and their supervisors) in two of Australia’s seventeen regional GP training providers (RTPs). Three other RTPs were the control group. Outcomes were proportion of registrars’ URTI consultations and bronchitis/bronchiolitis consultations prescribed antibiotics. Intention-to-treat analyses employed logistic regression within a Generalised Estimating Equation framework, adjusted for relevant independent variables. The predictors of interest were time; treatment group; and an interaction term for time-by-treatment group. The P value associated with an interaction term determined statistically significant differences in antibiotic prescribing.

Results
Analyses include data of 217 intervention RTPs’ and 311 control RTPs’ registrars. There was no significant reduction in antibiotic prescribing for URTIs. For bronchitis/bronchiolitis, a significant reduction (interaction P value = 0.024) remained true for analysis adjusted for independent variables (P value = 0.040). The adjusted absolute reduction in prescribing was 15.8% (95% CI: 4.2%–27.5%).

Conclusions
A multifaceted intervention reduced antibiotic prescribing for bronchitis/bronchiolitis but not URTIs.

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Accepted/In Press date: 19 June 2017
e-pub ahead of print date: 17 July 2017
Published date: 16 January 2018

Identifiers

Local EPrints ID: 415021
URI: http://eprints.soton.ac.uk/id/eprint/415021
ISSN: 0263-2136
PURE UUID: d6708191-b32e-488c-971d-3f44048e9a36
ORCID for Lucy Yardley: ORCID iD orcid.org/0000-0002-3853-883X

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Date deposited: 20 Oct 2017 16:31
Last modified: 17 Dec 2019 05:53

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