Parker Magin1,2, Amanda Tapley1,2, Simon Morgan3, Joshua S Davis1,4,5, Patrick McElduff1, Lucy Yardley6, Kim Henderson1,2, Anthea Dallas7, Lawrie McArthur8, Katie Mulquiney1,2, Andrew Davey1, Paul Little9, Neil Spike10,11, Mieke L van Driel12. 1. School of Medicine and Public Health, University of Newcastle, Newcastle, Australia. 2. NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organization, Newcastle, Australia. 3. Elermore Vale General Practice, Elermore Vale, Australia. 4. Menzies School of Health Research, Royal Darwin Hospital Campus, Casuarina, Australia. 5. John Hunter Hospital, New Lambton Heights, Australia. 6. Centre for Applications of Health Psychology, University of Southampton, Southampton, UK. 7. University of Notre Dame, Sydney, Australia. 8. Department of General Practice, University of Adelaide, Adelaide, Australia. 9. Primary Care & Population Sciences Academic Units, University of Southampton, Southampton, UK. 10. Department of General Practice, University of Melbourne, Melbourne, Australia. 11. Eastern Victoria General Practice Training, Melbourne, Australia. 12. Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Australia.
Abstract
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.
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.
Keywords:
Antibacterial agents; family practice; general practice; inappropriate prescribing; physician practice patterns; respiratory tract infections
Authors: Parker Magin; Amanda Tapley; Adrian J Dunlop; Andrew Davey; Mieke van Driel; Elizabeth Holliday; Simon Morgan; Kim Henderson; Jean Ball; Nigel Catzikiris; Katie Mulquiney; Neil Spike; Rohan Kerr; Simon Holliday Journal: J Gen Intern Med Date: 2018-07-23 Impact factor: 5.128
Authors: Marian S McDonagh; Kim Peterson; Kevin Winthrop; Amy Cantor; Brittany H Lazur; David I Buckley Journal: J Int Med Res Date: 2018-07-01 Impact factor: 1.671