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Effectiveness of GP online training and an information booklet for parents on antibiotic prescribing for children with RTI in primary care: a cluster randomised controlled trial

Effectiveness of GP online training and an information booklet for parents on antibiotic prescribing for children with RTI in primary care: a cluster randomised controlled trial
Effectiveness of GP online training and an information booklet for parents on antibiotic prescribing for children with RTI in primary care: a cluster randomised controlled trial
Objectives: Antibiotics are too often prescribed in childhood respiratory tract infection (RTI), despite limited effectiveness, potential side-effects, and bacterial resistance. We aimed to reduce antibiotic prescribing for children with RTI by online training for general practitioners (GP) and information for parents.

Methods: A pragmatic cluster randomised, controlled trial in primary care. The intervention consisted of an online training for GPs and an information booklet for parents. The primary outcome was the antibiotic prescription rate for children presenting with RTI symptoms, as registered by GPs. Secondary outcomes were number of reconsultations within the same disease episode, consultations for new episodes, hospital referrals and pharmacy dispensed antibiotic courses for children.

Results: After randomisation, GPs of in total 32 general practices registered 1009 consultations. An antibiotic was prescribed in 21% of consultations in the intervention group, compared to 33% in the usual care group, controlled for baseline prescribing (RR 0.65, 95% CI 0.46-0.91). The probability of reconsulting during the same RTI episode did not differ significantly between the intervention and control group, nor did the numbers of consultations for new episodes and hospital referrals. In the intervention group antibiotic dispensing was reduced with 32 courses per 1000 children/year, compared to the control group, and adjusted for baseline prescribing (RR 0.78, 95% CI 0.66-0.92). The numbers and proportion of second choice antibiotics did not differ significantly.

Conclusion: A concise, feasible, online GP training, with an information booklet for parents showed a relevant reduction in antibiotic prescribing for children with RTI.
This trial was registered at the Dutch Trial Register (NTR), registration number: NTR4240
0305-7453
1416-1422
Dekker, Anne R.J.
0c111ed9-757d-4b97-a28f-f8bdcf05fd9a
Verheij, Theo
772e019f-486f-4a64-9260-bac6446a85d2
Broekhuizen, Berna D.L.
58780c58-a133-4b22-ab3d-b30261859a62
Butler, Christopher C.
2782a915-eb8d-48bb-ae70-118114697f57
Cals, Jochen W.
cf15c88f-856d-4793-b26a-c38aa85556ab
Francis, Nick
9b610883-605c-4fee-871d-defaa86ccf8e
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Sanders, Elisabeth A.M.
0bdc6f65-491d-4668-b3b3-2d9317aa3c89
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Zuithoff, Nicolaas P.A.
1b152e26-e7c7-4b88-b231-26c410726393
van der Velden, Alike W.
1ad78cb7-b556-42fc-a530-aa2d6d53b758
Dekker, Anne R.J.
0c111ed9-757d-4b97-a28f-f8bdcf05fd9a
Verheij, Theo
772e019f-486f-4a64-9260-bac6446a85d2
Broekhuizen, Berna D.L.
58780c58-a133-4b22-ab3d-b30261859a62
Butler, Christopher C.
2782a915-eb8d-48bb-ae70-118114697f57
Cals, Jochen W.
cf15c88f-856d-4793-b26a-c38aa85556ab
Francis, Nick
9b610883-605c-4fee-871d-defaa86ccf8e
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Sanders, Elisabeth A.M.
0bdc6f65-491d-4668-b3b3-2d9317aa3c89
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Zuithoff, Nicolaas P.A.
1b152e26-e7c7-4b88-b231-26c410726393
van der Velden, Alike W.
1ad78cb7-b556-42fc-a530-aa2d6d53b758

Dekker, Anne R.J., Verheij, Theo, Broekhuizen, Berna D.L., Butler, Christopher C., Cals, Jochen W., Francis, Nick, Little, Paul, Sanders, Elisabeth A.M., Yardley, Lucy, Zuithoff, Nicolaas P.A. and van der Velden, Alike W. (2018) Effectiveness of GP online training and an information booklet for parents on antibiotic prescribing for children with RTI in primary care: a cluster randomised controlled trial. Journal of Antimicrobial Chemotherapy, 73 (5), 1416-1422. (doi:10.1093/jac/dkx542).

Record type: Article

Abstract

Objectives: Antibiotics are too often prescribed in childhood respiratory tract infection (RTI), despite limited effectiveness, potential side-effects, and bacterial resistance. We aimed to reduce antibiotic prescribing for children with RTI by online training for general practitioners (GP) and information for parents.

Methods: A pragmatic cluster randomised, controlled trial in primary care. The intervention consisted of an online training for GPs and an information booklet for parents. The primary outcome was the antibiotic prescription rate for children presenting with RTI symptoms, as registered by GPs. Secondary outcomes were number of reconsultations within the same disease episode, consultations for new episodes, hospital referrals and pharmacy dispensed antibiotic courses for children.

Results: After randomisation, GPs of in total 32 general practices registered 1009 consultations. An antibiotic was prescribed in 21% of consultations in the intervention group, compared to 33% in the usual care group, controlled for baseline prescribing (RR 0.65, 95% CI 0.46-0.91). The probability of reconsulting during the same RTI episode did not differ significantly between the intervention and control group, nor did the numbers of consultations for new episodes and hospital referrals. In the intervention group antibiotic dispensing was reduced with 32 courses per 1000 children/year, compared to the control group, and adjusted for baseline prescribing (RR 0.78, 95% CI 0.66-0.92). The numbers and proportion of second choice antibiotics did not differ significantly.

Conclusion: A concise, feasible, online GP training, with an information booklet for parents showed a relevant reduction in antibiotic prescribing for children with RTI.
This trial was registered at the Dutch Trial Register (NTR), registration number: NTR4240

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Dekker antimicrobial chemotherapy - Accepted Manuscript
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More information

Accepted/In Press date: 27 December 2017
e-pub ahead of print date: 9 February 2018
Published date: May 2018

Identifiers

Local EPrints ID: 420716
URI: http://eprints.soton.ac.uk/id/eprint/420716
ISSN: 0305-7453
PURE UUID: 056b1aab-a62b-452d-84d8-747672b6a1a0
ORCID for Nick Francis: ORCID iD orcid.org/0000-0001-8939-7312
ORCID for Lucy Yardley: ORCID iD orcid.org/0000-0002-3853-883X

Catalogue record

Date deposited: 11 May 2018 16:31
Last modified: 30 Jan 2020 05:01

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