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

Magin, Parker, 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). pp. 53-60.

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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.

Item ID: 75244
Item Type: Article (Research - C1)
ISSN: 1460-2229
Keywords: Antibacterial agents, Family practice, General practice, Inappropriate prescribing, Physician practice patterns, Respiratory tract infections
Copyright Information: © The Author(s) 2017. Published by Oxford University Press. All rights reserved.
Date Deposited: 18 Aug 2022 00:57
FoR Codes: 39 EDUCATION > 3901 Curriculum and pedagogy > 390110 Medicine, nursing and health curriculum and pedagogy @ 30%
42 HEALTH SCIENCES > 4203 Health services and systems > 420304 General practice @ 70%
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