Multimodal Stewardship Programme to Improve Antibiotic Prescribing for Children With Lower Respiratory Tract Infections (PRACTICE-LRTI)
Promoting Rational Antibiotic Choices Through Targeted Intervention and Clinician Education: a Prospective Nationwide Multimodal Intervention to Improve Guideline-Concordant Outpatient Antibiotic Prescribing for Pediatric Lower Respiratory Tract Infections
Children with lower respiratory tract infection (LRTI) are still often prescribed antibiotics in ways that depart from national guidelines. Acute viral bronchitis is treated with antibiotics although none are needed, and community-acquired pneumonia (CAP) is often treated with a second-choice antibiotic, most often a macrolide, instead of first-line amoxicillin. In the Terveystalo network in Finland, about one third of bronchitis visits and one fifth of CAP visits in 2014 to 2020 led to an antibiotic prescription, and macrolides were the most commonly prescribed agent for bronchitis.
PRACTICE-LRTI is a nationwide quality-improvement and implementation study in which all clinics of the network receive a multimodal antimicrobial stewardship programme aimed at prescribing clinicians (paediatricians, general practitioners, ear, nose and throat specialists and other physicians). The programme combines (1) a concise local version of the Finnish Current Care Guideline for paediatric LRTI; (2) education for physicians and caregivers (printed and intranet materials, videos, webinars, unit-level meetings, online courses and commitment posters); (3) light-touch electronic health record reminders and a one-click supportive-care order set; and (4) a real-time prescribing dashboard with a structured feedback cascade that escalates over three years from network-wide progress reports to targeted outreach to non-improving units and, finally, personalised letters and phone calls to persistently non-concordant prescribers. A one-page guide prompts clinicians to question unverified penicillin-allergy labels.
The programme is delivered to the whole network at the same time, so no clinics are randomised to a control condition. Instead, prescribing is followed as a monthly time series from 2014 onward, and the change after each of three prespecified intervention steps is estimated by segmented regression against the projected pre-intervention trend. The co-primary outcomes are the proportion of acute bronchitis episodes in which a systemic antibiotic is prescribed and the proportion of antibiotic-treated outpatient CAP episodes in which a non-first-line agent is prescribed. The co-primary outcomes are assessed at Month 36 after launch; their Month 12 and Month 48 assessments are secondary outcomes. Other secondary outcomes include first-line amoxicillin and macrolide use, 5-day treatment duration, variation between units and physicians, diagnostic testing, first-line prescribing in children with a penicillin-allergy label, and intervention cost. Safety is monitored through 14-day respiratory revisits, hospital referrals and hospitalisations. The active intervention lasts 3 years and is followed by 1 year of follow-up to assess durability.
This is a quality-improvement and implementation study embedded in routine care, not a trial of a treatment. The intervention is directed at physicians; no child is recruited, contacted or examined outside routine care, and all outcome data come from the network's electronic health record.
Panoramica dello studio
Stato
Intervento / Trattamento
Descrizione dettagliata
Design. Prospective, pragmatic, multicentre quality-improvement and implementation study with a multi-step interrupted time-series (ITS) evaluation and continuous electronic health record (EHR) surveillance in a nationwide private healthcare network in Finland (about 300 clinics, about 300,000 paediatric outpatient visits per year). Cluster randomisation is not feasible because the network has centralised medical leadership, a unified EHR, shared quality surveillance and a common intranet, so company-wide materials would contaminate any control clusters; for the same reason the managerial components (unit feedback, outreach, letters and calls) cannot be staggered or randomised across units. The counterfactual is provided by an extended pre-intervention baseline (published 2014 to 2020 series plus a monthly series from January 2021 to December 2026, the month before Day 0) and segmented-regression modelling of level and trend.
Intervention. Four components delivered in three annual graduated steps. Step 1 (Months 1 to 12): company-wide launch of the local guideline, workflow aids, physician and caregiver videos, nationwide online meetings, in-person unit meetings, online courses, caregiver leaflet, EHR reminders, live dashboard, quarterly progress reports and a first round of direct feedback from the Chief Medical Officer for Paediatrics and unit Chief Medical Officers. Step 2 (Months 13 to 24): targeted outreach to non-improving units and physicians, repeat unit meetings, intensified direct feedback. Step 3 (Months 25 to 36): personalised letters to persistently non-concordant prescribers, phone calls where letters do not change practice, recognition of high performers. Year 4 (Months 37 to 48): follow-up without new active push. Delivery of every component is logged prospectively and reported as process and fidelity measures alongside the outcome measures: online-course completion, webinar attendance and unit-meeting delivery (education reach), materials deployment, EHR reminder display and supportive-care order-set use, dashboard access, and the number and timing of direct feedback sessions, personalised letters and phone calls with the proportion of planned leadership acts delivered on schedule. From Month -6 every leadership act (report, meeting, letter, call) is recorded with timestamp, deliverer, recipient and planned date in a leadership log.
Unit of analysis. The LRTI episode: the index visit plus related visits within 14 days for the same child and diagnostic group. Children are analysed in three age groups (under 5, 5 to 9 and 10 to 17 years) and stratified by sex, physician specialty and unit or region.
Analysis. Primary analysis: segmented binomial regression of monthly proportions with a level-change indicator and trend-change term at Day 0 and prespecified secondary change points at Month 13, Month 25 and Month 37, harmonic seasonal terms, COVID-period indicators, and correction for autocorrelation (Newey-West or Prais-Winsten; ARIMA as robustness check). Primary estimand: absolute difference between observed and counterfactual proportions at Month 36, with 95% confidence intervals (delta method, verified by parametric bootstrap); the same estimand at Month 12 and Month 48 is secondary. The two co-primary outcomes are tested conjunctively at two-sided alpha 0.05 each. Secondary analyses: three-level multilevel logistic regression (episodes within physicians within units) with variance components summarised as intraclass correlation and median odds ratio; funnel plots and statistical process control charts; a prespecified physician-level dose-response analysis of educational exposure and a unit-level engagement-response analysis; matched before-after comparison of personalised-feedback recipients with negative-control selection in a baseline year; an explanatory leadership-effect analysis (within-clinician comparison across units for clinicians who work in more than one unit, leadership dose-response, and an event-study of the dates on which unit feedback was delivered); prespecified subgroup, sensitivity and quantitative bias analyses, including quarterly aggregation of the CAP series, an indicator term for the preparatory-phase months (July to December 2026), a placebo interruption date and a negative-control outcome (antibiotic prescribing for paediatric urinary tract infection). Balancing and safety outcomes (14-day respiratory revisit, hospital referral, 30-day LRTI hospitalisation, CRP testing or chest radiography in bronchitis episodes as a substitution signal, antibiotic-allergy labels, and visit-level patient satisfaction) are followed on monthly run charts with prespecified signal thresholds and analysed with the same ITS models. A prespecified health-economic evaluation (cost-consequence analysis with cost-effectiveness ratios, provider perspective, CHEERS 2022) quantifies intervention costs by component and step against antibiotic-related savings derived from the ITS counterfactual.
Sample size. All eligible episodes are included (about 10,000 bronchitis and 2,000 to 2,500 CAP episodes per year, of which about 450 to 560 CAP episodes are antibiotic-treated and form the denominator of the CAP co-primary outcome), giving precision to detect absolute changes of about 3 percentage points in bronchitis prescribing and about 5 points in CAP agent selection. No formal power calculation governs inclusion.
Registration and reporting. The statistical analysis plan (version 1.0) was frozen on 29 October 2026 on deposition with this record, before Day 0, and is attached as a study document; it is also published as a supplement to the protocol paper. Analyses are conducted by the principal investigator with Terveystalo's statistical team and the research group's statistician; the analysis plan, analysis code and co-intervention log are published with the results. Reporting follows SQUIRE 2.0, TIDieR and EPOC guidance for interrupted time series.
Tipo di studio
Iscrizione (Stimato)
Fase
- Non applicabile
Contatti e Sedi
Contatto studio
- Nome: Péter Csonka, MD, PhD
- Numero di telefono: +358 50 366 1103
- Email: peter.csonka@tuni.fi
Luoghi di studio
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Helsinki, Finlandia, 00100
- Terveystalo (nationwide network, about 300 clinics)
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Criteri di partecipazione
Criteri di ammissibilità
Età idonea allo studio
Accetta volontari sani
Sessi ammissibili allo studio
Descrizione
Patient-episode inclusion criteria:
- Age under 18 years at the visit
- Outpatient or primary-care visit at a clinic of the Terveystalo network in Finland
- Main or secondary ICD-10 diagnosis of acute bronchitis (J20 to J22) or community-acquired pneumonia or unspecified lower respiratory tract infection (J09 to J18.9 according to the protocol code list)
Patient-episode exclusion criteria:
- Concomitant bacterial diagnosis that independently warrants antibiotics (for example urinary tract infection or streptococcal pharyngitis), or LRTI complicated by acute otitis media or sinusitis
- Chronic condition requiring long-term or prophylactic antibiotics (for example cystic fibrosis, immunodeficiency, bronchiectasis)
- Records with critical missing structured fields (enumerated and reported)
Clinicians: all physicians who record an eligible LRTI visit in the network during the study period receive the programme; there are no clinician exclusion criteria. The intervention targets prescribing clinicians; outcomes are measured on patient episodes identified from routinely collected electronic health record data without recruitment or contact.
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Ricerca sui servizi sanitari
- Assegnazione: N / A
- Modello interventistico: Assegnazione di gruppo singolo
- Mascheramento: Nessuno (etichetta aperta)
Armi e interventi
Gruppo di partecipanti / Arm |
Intervento / Trattamento |
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Sperimentale: Multimodal stewardship programme (whole network)
All prescribing clinicians and all clinics of the Terveystalo network receive the four-component programme in three graduated annual steps. Outcomes are measured on all eligible paediatric LRTI episodes recorded in the network's EHR before, during and after the intervention. |
Four components in three annual steps. (1) Guideline reinforcement: concise local version of the Finnish Current Care Guideline for paediatric LRTI (no antibiotics for bronchitis; amoxicillin 40 to 45 mg/kg/day for 5 days as first-line for uncomplicated CAP; macrolide only for suspected Mycoplasma; indications for CRP and chest radiography). (2) Multimodal education: printed and intranet materials, physician and caregiver videos, webinars, unit meetings, online courses, commitment posters, caregiver leaflet. (3) EHR support: non-blocking diagnosis-specific reminders, allergy-label prompt, one-click supportive-care order set. (4) Real-time dashboard and feedback cascade: physician-, unit- and network-level indicators on SPC charts; quarterly reports; direct feedback from the Head of Pediatrics and unit Chief Medical Officers; in Step 3, personalised letters and calls to persistently non-concordant prescribers. A one-page guide prompts questioning of unverified penicillin-allergy labels.
Altri nomi:
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Cosa sta misurando lo studio?
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Proportion of acute bronchitis episodes with a systemic antibiotic prescription
Lasso di tempo: Month 36 after programme launch
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Proportion of eligible acute bronchitis episodes (index visit plus related visits within 14 days for the same child) with at least one systemic antibiotic prescription, measured in Month 36 after programme launch (end of Step 3). Unit of measure: percentage of episodes. The intervention effect is reported as the absolute difference in percentage points, with 95% confidence interval, between the observed proportion and the counterfactual proportion projected from the pre-launch monthly series (published 2014 to 2020 series extended month by month to the month before launch), estimated by segmented binomial regression. Target: below 15% (minimum acceptable below 20%) from a baseline of 32%. |
Month 36 after programme launch
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Proportion of antibiotic-treated outpatient community-acquired pneumonia episodes with a non-first-line antibiotic
Lasso di tempo: Month 36 after programme launch
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Proportion of antibiotic-treated outpatient community-acquired pneumonia (CAP) episodes in which a non-first-line agent is prescribed, defined as any systemic antibiotic other than amoxicillin (ATC J01CA04); the non-first-line share is the complement of the amoxicillin share, measured in Month 36 after programme launch (end of Step 3). Unit of measure: percentage of antibiotic-treated CAP episodes. The intervention effect is reported as the absolute difference in percentage points, with 95% confidence interval, between the observed proportion and the counterfactual proportion projected from the pre-launch monthly series, estimated by segmented binomial regression. Corresponds to the target of increasing first-line amoxicillin from 65% to above 80% of antibiotic-treated CAP. |
Month 36 after programme launch
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Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Proportion of acute bronchitis episodes with a systemic antibiotic prescription at Month 12
Lasso di tempo: Month 12 after programme launch
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Same measurement and analysis as the first co-primary outcome, assessed in Month 12 after programme launch (end of Step 1). Unit of measure: percentage of episodes; effect reported as the absolute difference in percentage points from the counterfactual, with 95% confidence interval. |
Month 12 after programme launch
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Proportion of acute bronchitis episodes with a systemic antibiotic prescription at Month 48
Lasso di tempo: Month 48 after programme launch
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Same measurement and analysis as the first co-primary outcome, assessed in Month 48 after programme launch (end of the 1-year follow-up without new active intervention), as the measure of durability. Unit of measure: percentage of episodes; effect reported as the absolute difference in percentage points from the counterfactual, with 95% confidence interval. |
Month 48 after programme launch
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Proportion of antibiotic-treated outpatient community-acquired pneumonia episodes with a non-first-line antibiotic at Month 12
Lasso di tempo: Month 12 after programme launch
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Same measurement and analysis as the second co-primary outcome, assessed in Month 12 after programme launch (end of Step 1). Unit of measure: percentage of antibiotic-treated CAP episodes; effect reported as the absolute difference in percentage points from the counterfactual, with 95% confidence interval. |
Month 12 after programme launch
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Proportion of antibiotic-treated outpatient community-acquired pneumonia episodes with a non-first-line antibiotic at Month 48
Lasso di tempo: Month 48 after programme launch
|
Same measurement and analysis as the second co-primary outcome, assessed in Month 48 after programme launch (end of the 1-year follow-up), as the measure of durability. Unit of measure: percentage of antibiotic-treated CAP episodes; effect reported as the absolute difference in percentage points from the counterfactual, with 95% confidence interval. |
Month 48 after programme launch
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Proportion of antibiotic-treated outpatient community-acquired pneumonia episodes treated with amoxicillin
Lasso di tempo: Month 36 after programme launch
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Proportion of antibiotic-treated outpatient CAP episodes in which amoxicillin (ATC J01CA04) is the prescribed antibiotic, measured in Month 36 after programme launch. Unit of measure: percentage of antibiotic-treated CAP episodes. Analysed by segmented regression against the pre-launch counterfactual. Target: above 80%. |
Month 36 after programme launch
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Proportion of antibiotic-treated outpatient community-acquired pneumonia episodes with a macrolide prescription
Lasso di tempo: Month 36 after programme launch
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Proportion of antibiotic-treated outpatient CAP episodes in which a macrolide (ATC J01FA) is prescribed, measured in Month 36 after programme launch. Unit of measure: percentage of antibiotic-treated CAP episodes. Analysed by segmented regression against the pre-launch counterfactual. Target: below 10%. |
Month 36 after programme launch
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Proportion of acute bronchitis episodes with a macrolide prescription
Lasso di tempo: Month 36 after programme launch
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Proportion of eligible acute bronchitis episodes in which a macrolide (ATC J01FA) is prescribed, measured in Month 36 after programme launch. Unit of measure: percentage of episodes. Analysed by segmented regression against the pre-launch counterfactual. |
Month 36 after programme launch
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Proportion of community-acquired pneumonia amoxicillin courses with a prescribed duration of 5 days or less
Lasso di tempo: Month 36 after programme launch
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Proportion of amoxicillin courses prescribed for outpatient CAP with a prescribed duration of 5 days or less (guideline-concordant duration), measured in Month 36 after programme launch. Unit of measure: percentage of CAP amoxicillin courses. Analysed by segmented regression against the pre-launch counterfactual. Target: above 50%. |
Month 36 after programme launch
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Median odds ratio between units for antibiotic prescribing in acute bronchitis
Lasso di tempo: Step 3 period, Months 25 to 36 after programme launch
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Median odds ratio (MOR) for the unit level from a three-level multilevel logistic regression (eligible acute bronchitis episodes within physicians within units) of systemic antibiotic prescribing, estimated for the Step 3 period. The same model is fitted to the pre-launch baseline period and to each study period so that the change in between-unit variation can be described. Unit of measure: odds ratio (dimensionless). |
Step 3 period, Months 25 to 36 after programme launch
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Median odds ratio between physicians for antibiotic prescribing in acute bronchitis
Lasso di tempo: Step 3 period, Months 25 to 36 after programme launch
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Median odds ratio (MOR) for the physician level from the same three-level multilevel logistic regression of systemic antibiotic prescribing in eligible acute bronchitis episodes, estimated for the Step 3 period and, for comparison, for the pre-launch baseline period and each study period. Unit of measure: odds ratio (dimensionless). |
Step 3 period, Months 25 to 36 after programme launch
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Median odds ratio between units for non-first-line antibiotic prescribing in community-acquired pneumonia
Lasso di tempo: Step 3 period, Months 25 to 36 after programme launch
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Median odds ratio (MOR) for the unit level from a three-level multilevel logistic regression (antibiotic-treated outpatient CAP episodes within physicians within units) of non-first-line agent prescribing, estimated for the Step 3 period and, for comparison, for the pre-launch baseline period and each study period. Unit of measure: odds ratio (dimensionless). |
Step 3 period, Months 25 to 36 after programme launch
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Median odds ratio between physicians for non-first-line antibiotic prescribing in community-acquired pneumonia
Lasso di tempo: Step 3 period, Months 25 to 36 after programme launch
|
Median odds ratio (MOR) for the physician level from the same three-level multilevel logistic regression of non-first-line agent prescribing in antibiotic-treated outpatient CAP episodes, estimated for the Step 3 period and, for comparison, for the pre-launch baseline period and each study period. Unit of measure: odds ratio (dimensionless). |
Step 3 period, Months 25 to 36 after programme launch
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Proportion of lower respiratory tract infection episodes coded as pneumonia or unspecified lower respiratory tract infection
Lasso di tempo: Month 36 after programme launch
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Proportion of all eligible lower respiratory tract infection (LRTI) episodes coded as community-acquired pneumonia or unspecified LRTI rather than acute bronchitis, measured in Month 36 after programme launch, to detect shifts in diagnostic labelling during the intervention. Unit of measure: percentage of eligible LRTI episodes. Analysed by segmented regression against the pre-launch counterfactual. |
Month 36 after programme launch
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Proportion of lower respiratory tract infection episodes with diagnostic testing
Lasso di tempo: Month 36 after programme launch
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Proportion of eligible LRTI episodes in which any of C-reactive protein (CRP) testing, rapid viral or influenza testing, or chest radiography is ordered at the index visit, each episode counted once regardless of the number or type of tests, measured in Month 36 after programme launch. Unit of measure: percentage of eligible LRTI episodes. Analysed by segmented regression against the pre-launch counterfactual. |
Month 36 after programme launch
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Proportion of amoxicillin treatment among antibiotic-treated community-acquired pneumonia episodes with a documented penicil penicillin-class allergy label
Lasso di tempo: Month 36 after programme launch
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Among antibiotic-treated outpatient CAP episodes in which the child has a documented penicillin-class allergy label on file at the visit, the proportion treated with amoxicillin (ATC J01CA04), measured in Month 36 after programme launch. Unit of measure: percentage of allergy-labelled antibiotic-treated CAP episodes. Analysed by segmented regression against the pre-launch counterfactual. |
Month 36 after programme launch
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Total intervention cost
Lasso di tempo: Cumulative from Month -6 (start of the preparatory phase) through Month 48 after programme launch
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Prospectively logged cost of delivering the programme (micro-costing of personnel time, materials, EHR development and feedback activities), summed across components and steps from the start of the preparatory phase to the end of the follow-up year. Unit of measure: euros. Reported with a breakdown by component and step (provider perspective, CHEERS 2022). |
Cumulative from Month -6 (start of the preparatory phase) through Month 48 after programme launch
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Net programme cost
Lasso di tempo: Cumulative from Month -6 (start of the preparatory phase) through Month 48 after programme launch
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Total intervention cost minus the direct antibiotic cost savings attributable to the programme, where savings are derived from the difference between observed and counterfactual antibiotic prescribing in the interrupted time series. Unit of measure: euros, with bootstrap 95% confidence interval (provider perspective). |
Cumulative from Month -6 (start of the preparatory phase) through Month 48 after programme launch
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Cost per averted acute bronchitis antibiotic course
Lasso di tempo: Cumulative from Month -6 (start of the preparatory phase) through Month 48 after programme launch
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Net programme cost divided by the number of systemic antibiotic courses for acute bronchitis averted relative to the interrupted time series counterfactual over the same period (cost-consequence analysis, provider perspective). Unit of measure: euros per averted antibiotic course, with bootstrap 95% confidence interval. |
Cumulative from Month -6 (start of the preparatory phase) through Month 48 after programme launch
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Cost per additional first-line-treated community-acquired pneumonia episode
Lasso di tempo: Cumulative from Month -6 (start of the preparatory phase) through Month 48 after programme launch
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Net programme cost divided by the number of additional antibiotic-treated outpatient CAP episodes treated with a first-line agent relative to the interrupted time series counterfactual over the same period (cost-consequence analysis, provider perspective). Unit of measure: euros per additional first-line-treated episode, with bootstrap 95% confidence interval. |
Cumulative from Month -6 (start of the preparatory phase) through Month 48 after programme launch
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Altre misure di risultato
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Proportion of lower respiratory tract infection episodes with a respiratory revisit within 14 days (balancing outcome)
Lasso di tempo: Month 36 after programme launch
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Proportion of eligible LRTI episodes followed by a respiratory revisit within 14 days of the index visit, measured in Month 36 after programme launch. Unit of measure: percentage of eligible LRTI episodes. Followed monthly on run charts from launch and analysed by segmented regression against the pre-launch counterfactual. Prespecified safety signal: intervention-attributable absolute increase exceeding 1 percentage point. |
Month 36 after programme launch
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Proportion of lower respiratory tract infection episodes with a hospital referral (balancing outcome)
Lasso di tempo: Month 36 after programme launch
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Proportion of eligible LRTI episodes with a hospital referral at or after the index visit within the episode, measured in Month 36 after programme launch. Unit of measure: percentage of eligible LRTI episodes. Followed monthly on run charts from launch and analysed by segmented regression against the pre-launch counterfactual. |
Month 36 after programme launch
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Proportion of lower respiratory tract infection episodes with hospitalisation for lower respiratory tract infection within 30 days (balancing outcome)
Lasso di tempo: Month 36 after programme launch
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Proportion of eligible LRTI episodes followed by hospitalisation for LRTI within 30 days of the index visit, measured in Month 36 after programme launch. Unit of measure: percentage of eligible LRTI episodes. Followed monthly on run charts from launch and analysed by segmented regression against the pre-launch counterfactual. Any statistically significant intervention-attributable increase is a prespecified safety signal. |
Month 36 after programme launch
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Proportion of acute bronchitis episodes with C-reactive protein testing or chest radiography (substitution signal)
Lasso di tempo: Month 36 after programme launch
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Proportion of eligible acute bronchitis episodes in which CRP testing or chest radiography, or both, is ordered at the index visit, each episode counted once, measured in Month 36 after programme launch. Unit of measure: percentage of acute bronchitis episodes. An increase while antibiotic prescribing falls is interpreted as testing substituting for antibiotics rather than guideline-concordant care. Analysed by segmented regression against the pre-launch counterfactual. |
Month 36 after programme launch
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Proportion of lower respiratory tract infection episodes with a documented penicillin-class allergy label (balancing outcome)
Lasso di tempo: Month 36 after programme launch
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Proportion of eligible LRTI episodes in which the child has a documented penicillin-class allergy label on file at the visit, measured in Month 36 after programme launch. Unit of measure: percentage of eligible LRTI episodes. Followed monthly from launch and analysed by segmented regression against the pre-launch counterfactual. |
Month 36 after programme launch
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Mean Net Promoter Score for lower respiratory tract infection visits (balancing outcome)
Lasso di tempo: Month 36 after programme launch
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Mean of the Terveystalo visit-level Net Promoter Score question (0 to 10 scale, higher is more favourable) among eligible LRTI visits with a returned score, measured in Month 36 after programme launch. Unit of measure: score on a 0 to 10 scale. Followed monthly from launch and analysed by segmented regression against the pre-launch counterfactual. |
Month 36 after programme launch
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Proportion of promoters among lower respiratory tract infection visits (balancing outcome)
Lasso di tempo: Month 36 after programme launch
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Proportion of eligible LRTI visits with a returned Net Promoter Score of 9 or 10 (promoters), measured in Month 36 after programme launch. Unit of measure: percentage of LRTI visits with a returned score. Followed monthly from launch and analysed by segmented regression against the pre-launch counterfactual. |
Month 36 after programme launch
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Within-clinician difference in acute bronchitis antibiotic prescribing between units with and without prior unit-level leadership exposure (explanatory)
Lasso di tempo: From programme launch through Month 36 after programme launch
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Among clinicians with eligible acute bronchitis episodes in two or more units in the same calendar month, the difference in the proportion of episodes with a systemic antibiotic prescription between units in which unit-level leadership exposure (unit Chief Medical Officer feedback delivered or unit meeting held, from the prospective leadership log) has already occurred and units in which it has not, pooled over Months 1 to 36 with clinician fixed effects. Unit of measure: percentage points. Reported as an explanatory lower bound of the site-bound leadership effect. |
From programme launch through Month 36 after programme launch
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Within-clinician difference in non-first-line antibiotic prescribing in community-acquired pneumonia between units with and without prior unit-level leadership exposure (explanatory)
Lasso di tempo: From programme launch through Month 36 after programme launch
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Among clinicians with antibiotic-treated outpatient CAP episodes in two or more units in the same calendar month, the difference in the proportion of episodes with a non-first-line agent between units with and without prior unit-level leadership exposure (defined as above), pooled over Months 1 to 36 with clinician fixed effects. Unit of measure: percentage points. Reported as an explanatory lower bound of the site-bound leadership effect. |
From programme launch through Month 36 after programme launch
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Collaboratori e investigatori
Sponsor
Investigatori
- Investigatore principale: Péter Csonka, MD, PhD, Tampere University; Terveystalo
Pubblicazioni e link utili
Pubblicazioni generali
- Korppi M, Heikkila P, Palmu S, Huhtala H, Csonka P. Antibiotic prescriptions for children with lower respiratory tract infections fell from 2014 to 2020, but misuse was still an issue. Acta Paediatr. 2022 Jun;111(6):1230-1237. doi: 10.1111/apa.16323. Epub 2022 Mar 11.
- Poutanen R, Korppi M, Csonka P, Pauniaho SL, Renko M, Palmu S. Use of antibiotics contrary to guidelines for children's lower respiratory tract infections in different health care settings. Eur J Pediatr. 2023 Oct;182(10):4369-4377. doi: 10.1007/s00431-023-05099-6. Epub 2023 Jul 19.
- Csonka P, Heikkila P, Koskela S, Palmu S, Lajunen N, Riihijarvi S, Huhtala H, Korppi M. Cough and cold medicine prescription rates can be significantly reduced by active intervention. Eur J Pediatr. 2022 Apr;181(4):1531-1539. doi: 10.1007/s00431-021-04344-0. Epub 2021 Dec 15.
- Poutanen R, Virta T, Heikkila P, Pauniaho SL, Csonka P, Korppi M, Renko M, Palmu S. National Current Care Guidelines for paediatric lower respiratory tract infections reduced the use of chest radiographs but local variations were observed. Acta Paediatr. 2021 May;110(5):1594-1600. doi: 10.1111/apa.15692. Epub 2020 Dec 7.
- Backman K, Helminen M, Kekalainen E, Mikkola I, Nieminen T, Nuolivirta K, Peltola V, Seuri R, Walle SM, Ruuska-Loewald T. Working group summary of the 2023 full update of the Finnish national guidelines for paediatric lower respiratory tract infections. Acta Paediatr. 2025 Feb;114(2):248-257. doi: 10.1111/apa.17481. Epub 2024 Nov 1.
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Termini relativi a questo studio
Parole chiave
Termini MeSH pertinenti aggiuntivi
Altri numeri di identificazione dello studio
- PRACTICE-LRTI-2027
- 2026-08-02 (Altro identificatore: Terveystalo Medical Executive Team approval)
Piano per i dati dei singoli partecipanti (IPD)
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Descrizione del piano IPD
No data are available at the protocol stage. Episode-level data are held by Terveystalo and cannot be shared by the investigators because they are confidential health data; third-party access to the underlying data is governed by Terveystalo and, where applicable, requires a Findata permit under the Finnish secondary-use act. The SAP, code lists, indicator definitions and intervention materials are provided as online supplemental material; analysis code will be provided at publication of results.
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