The University of Southampton
University of Southampton Institutional Repository

Effectiveness and safety of electronically-delivered prescribing feedback and decision support on antibiotic utilisation for respiratory illness in primary care. REDUCE cluster-randomised trial

Effectiveness and safety of electronically-delivered prescribing feedback and decision support on antibiotic utilisation for respiratory illness in primary care. REDUCE cluster-randomised trial
Effectiveness and safety of electronically-delivered prescribing feedback and decision support on antibiotic utilisation for respiratory illness in primary care. REDUCE cluster-randomised trial
Objectives: To evaluate the effectiveness and safety at population-scale of electronically delivered prescribing feedback and decision support interventions at reducing antibiotic (AB) prescribing for self-limiting respiratory infections (RTI).

Design: Open-label, two-arm, cluster randomised controlled trial

Setting: UK general practices in the Clinical Practice Research Datalink

Participants: 79 general practices (582,675 patient-years) randomised (1:1) to antimicrobial stewardship (AMS) intervention or usual care.
Interventions: The AMS intervention comprised a brief training webinar, automated monthly feedback reports of AB prescribing, and electronic decision support tools to inform appropriate AB prescribing over 12 months. Intervention components were delivered electronically, supported by a local practice ‘champion’.

Main outcome measures: The primary outcome was the rate of AB prescriptions for RTI from electronic health records. Serious bacterial complications were evaluated for safety. Analysis was by Poisson regression with general practice as a random effect, adjusting for covariates. Pre-specified sub-group analyses by age-group are reported.

Results: There were 41 AMS trial arm practices (323,155 patient-years) and 38 usual care trial arm practices (259,520 patient-years). AB prescribing rate ratios (RR) were: unadjusted, 0.89 (0.86 to 1.16); and adjusted, 0.88 (95% CI, 0.78 to 0.99, P=0.04); with AB prescribing rates of 98.7 per 1,000 patient-years for AMS (31,907 AB prescriptions) and 107.6 per 1,000 for usual care (27,923 AB prescriptions). AB prescribing was reduced most in adults aged 15-84 years (adjusted RR 0.84, 95%CI 0.75 to 0.95), with one antibiotic prescription per year avoided for every 62 (40 to 200) patients. There was no evidence of effect for children less than 15 years (adjusted RR 0.96, 0.82 to 1.12) or adults aged 85 years and older (adjusted RR 0.97, 0.79 to 1.18). There was no evidence that serious bacterial complications increased (adjusted RR 0.92, 0.74 to 1.13).

Conclusions: Electronically-delivered interventions, integrated into practice workflow result in moderate reductions AB prescribing for RTI in adults, which are likely to be of importance for public health. Antibiotic prescribing to children or older people requires further evaluation.

Trial registration: ISRCTN95232781
0959-8138
1-12
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Gulliford, Martin C.
5c557aa2-db12-43a2-8778-eac74cf42138
Prevost, A. Toby
5fd7066c-e170-46f6-8d3e-501532dc7810
Charlton, Judith
27682a6d-c126-45fb-a8a1-dbde57ccb4e9
Juszczyk, Dorota
c9c7c039-5bae-4c5f-8df7-75f30e7a9c53
Soames, Jamie
7e6dccf8-a923-4161-a2b6-b1fdd2c7e85c
McDermott, Lisa
10aa4fe3-7260-4080-8f8b-7c14b3ca409e
Sultana, Kirin
1d88fbae-5f1a-4fbd-82d8-3973262ea671
Wright, Mark
c9b1b302-436a-40d3-b3ea-456002f82248
Fox, Robin
df22d09d-ede6-42c8-99d7-563a14173c0c
Hay, Alastair D.
bfae9e44-ae9b-473c-923f-1dea50747023
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Ashworth, Mark
51302b16-d1e8-4221-a192-04aebdd16f77
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Gulliford, Martin C.
5c557aa2-db12-43a2-8778-eac74cf42138
Prevost, A. Toby
5fd7066c-e170-46f6-8d3e-501532dc7810
Charlton, Judith
27682a6d-c126-45fb-a8a1-dbde57ccb4e9
Juszczyk, Dorota
c9c7c039-5bae-4c5f-8df7-75f30e7a9c53
Soames, Jamie
7e6dccf8-a923-4161-a2b6-b1fdd2c7e85c
McDermott, Lisa
10aa4fe3-7260-4080-8f8b-7c14b3ca409e
Sultana, Kirin
1d88fbae-5f1a-4fbd-82d8-3973262ea671
Wright, Mark
c9b1b302-436a-40d3-b3ea-456002f82248
Fox, Robin
df22d09d-ede6-42c8-99d7-563a14173c0c
Hay, Alastair D.
bfae9e44-ae9b-473c-923f-1dea50747023
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Ashworth, Mark
51302b16-d1e8-4221-a192-04aebdd16f77

Little, Paul, Gulliford, Martin C., Prevost, A. Toby, Charlton, Judith, Juszczyk, Dorota, Soames, Jamie, McDermott, Lisa, Sultana, Kirin, Wright, Mark, Fox, Robin, Hay, Alastair D., Moore, Michael, Yardley, Lucy and Ashworth, Mark (2019) Effectiveness and safety of electronically-delivered prescribing feedback and decision support on antibiotic utilisation for respiratory illness in primary care. REDUCE cluster-randomised trial. British Medical Journal, 364 (1236), 1-12. (doi:10.1136/bmj.l236).

Record type: Article

Abstract

Objectives: To evaluate the effectiveness and safety at population-scale of electronically delivered prescribing feedback and decision support interventions at reducing antibiotic (AB) prescribing for self-limiting respiratory infections (RTI).

Design: Open-label, two-arm, cluster randomised controlled trial

Setting: UK general practices in the Clinical Practice Research Datalink

Participants: 79 general practices (582,675 patient-years) randomised (1:1) to antimicrobial stewardship (AMS) intervention or usual care.
Interventions: The AMS intervention comprised a brief training webinar, automated monthly feedback reports of AB prescribing, and electronic decision support tools to inform appropriate AB prescribing over 12 months. Intervention components were delivered electronically, supported by a local practice ‘champion’.

Main outcome measures: The primary outcome was the rate of AB prescriptions for RTI from electronic health records. Serious bacterial complications were evaluated for safety. Analysis was by Poisson regression with general practice as a random effect, adjusting for covariates. Pre-specified sub-group analyses by age-group are reported.

Results: There were 41 AMS trial arm practices (323,155 patient-years) and 38 usual care trial arm practices (259,520 patient-years). AB prescribing rate ratios (RR) were: unadjusted, 0.89 (0.86 to 1.16); and adjusted, 0.88 (95% CI, 0.78 to 0.99, P=0.04); with AB prescribing rates of 98.7 per 1,000 patient-years for AMS (31,907 AB prescriptions) and 107.6 per 1,000 for usual care (27,923 AB prescriptions). AB prescribing was reduced most in adults aged 15-84 years (adjusted RR 0.84, 95%CI 0.75 to 0.95), with one antibiotic prescription per year avoided for every 62 (40 to 200) patients. There was no evidence of effect for children less than 15 years (adjusted RR 0.96, 0.82 to 1.12) or adults aged 85 years and older (adjusted RR 0.97, 0.79 to 1.18). There was no evidence that serious bacterial complications increased (adjusted RR 0.92, 0.74 to 1.13).

Conclusions: Electronically-delivered interventions, integrated into practice workflow result in moderate reductions AB prescribing for RTI in adults, which are likely to be of importance for public health. Antibiotic prescribing to children or older people requires further evaluation.

Trial registration: ISRCTN95232781

Text
BMJ Revised Submission 04 Dec 2018 - Accepted Manuscript
Available under License Creative Commons Attribution.
Download (1MB)
Text
bmj.l236.full - Version of Record
Available under License Creative Commons Attribution.
Download (1MB)

More information

Accepted/In Press date: 31 December 2018
e-pub ahead of print date: 13 February 2019

Identifiers

Local EPrints ID: 427179
URI: https://eprints.soton.ac.uk/id/eprint/427179
ISSN: 0959-8138
PURE UUID: edcaa29b-15d4-4807-9ac3-bf430e2de5bc
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: 04 Jan 2019 17:30
Last modified: 12 Jul 2019 00:36

Export record

Altmetrics

Contributors

Author: Paul Little
Author: Martin C. Gulliford
Author: A. Toby Prevost
Author: Judith Charlton
Author: Dorota Juszczyk
Author: Jamie Soames
Author: Lisa McDermott
Author: Kirin Sultana
Author: Mark Wright
Author: Robin Fox
Author: Alastair D. Hay
Author: Michael Moore ORCID iD
Author: Lucy Yardley ORCID iD
Author: Mark Ashworth

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of https://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×