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

Paul Little, Beth Stuart, Nick Francis, Elaine Douglas, Sarah Tonkin-Crine, Sibyl Anthierens, Jochen W L Cals, Hasse Melbye, Miriam Santer, Michael Moore, Samuel Coenen, Chris Butler, Kerenza Hood, Mark Kelly, Maciek Godycki-Cwirko, Artur Mierzecki, Antoni Torres, Carl Llor, Melanie Davies, Mark Mullee, Gilly O'Reilly, Alike van der Velden, Adam W A Geraghty, Herman Goossens, Theo Verheij, Lucy Yardley, GRACE consortium, Niels Adriaenssens, Juande Alcántara, Javier Arranz, Zuzana Bielicka, Francesco Blasi, Pascale Bruno, Curt Brugman, Jo Coast, Josep Maria Cots, Patricia Fernandez, Guillermo García, Iris Hering, Helena Hupkova, Greet Ieven, Anna Kowalczyk, Jaroslaw Krawczyk, Christine Lammens, Christina Lannering, Marieke Lemiengre, Frank Leus, Katherine Loens, Ana Moragas, Nuria Sanchez-Ruano, Matteu Serra Prat, Richard Smith, Tom Schaberg, Ann de Sutter, Igor Svab, Jackie Swain, Pia Touboul, Robert Veen, Tricia Worby, Patrick Bindels, Gordon Taylor, Mark Woodhead, Paul Little, Beth Stuart, Nick Francis, Elaine Douglas, Sarah Tonkin-Crine, Sibyl Anthierens, Jochen W L Cals, Hasse Melbye, Miriam Santer, Michael Moore, Samuel Coenen, Chris Butler, Kerenza Hood, Mark Kelly, Maciek Godycki-Cwirko, Artur Mierzecki, Antoni Torres, Carl Llor, Melanie Davies, Mark Mullee, Gilly O'Reilly, Alike van der Velden, Adam W A Geraghty, Herman Goossens, Theo Verheij, Lucy Yardley, GRACE consortium, Niels Adriaenssens, Juande Alcántara, Javier Arranz, Zuzana Bielicka, Francesco Blasi, Pascale Bruno, Curt Brugman, Jo Coast, Josep Maria Cots, Patricia Fernandez, Guillermo García, Iris Hering, Helena Hupkova, Greet Ieven, Anna Kowalczyk, Jaroslaw Krawczyk, Christine Lammens, Christina Lannering, Marieke Lemiengre, Frank Leus, Katherine Loens, Ana Moragas, Nuria Sanchez-Ruano, Matteu Serra Prat, Richard Smith, Tom Schaberg, Ann de Sutter, Igor Svab, Jackie Swain, Pia Touboul, Robert Veen, Tricia Worby, Patrick Bindels, Gordon Taylor, Mark Woodhead

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.

Funding: European Commission Framework Programme 6, National Institute for Health Research, Research Foundation Flanders.

Copyright © 2013 Elsevier Ltd. All rights reserved.

Figures

Figure
Figure
Trial profile CRP=C-reactive protein.

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Source: PubMed

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