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

Parker J. Magin, Amanda Tapley, Simon Morgan, Joshua Davis, Patrick McElduff, Lucy Yardley, Kim Henderson, Anthea Dallas, Lawrie McArthur, Katie Mulquiney, Andrew Davey, Paul Little, Neil A. Spike, Mieke L. Van Driel

    Research output: Contribution to journalArticle

    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.

    Original languageEnglish
    Pages (from-to)53-60
    Number of pages8
    JournalFamily Practice
    Volume35
    Issue number1
    Early online date17 Jul 2017
    DOIs
    Publication statusPublished - 1 Feb 2018

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