Effectiveness of a multiple intervention to reduce antibiotic prescribing for respiratory tract symptoms in primary care: randomised controlled trial

doi:10.1136/bmj.38182.591238.EB

BMJ 2004;329:431 (21 August), doi:10.1136/bmj.38182.591238.EB (published 5 August 2004)

Primary care

Effectiveness of a multiple intervention to reduce antibiotic prescribing for respiratory tract symptoms in primary care: randomised controlled trial

Ineke Welschen, junior researcher¹, Marijke M Kuyvenhoven, associate professor¹, Arno W Hoes, professor of clinical epidemiology¹, Theo J M Verheij, professor of general practice¹

¹ University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, PO Box 85060, 3508 AB Utrecht, Netherlands

Correspondence to: I. Welschen i.welschen{at}med.uu.nl

Objectives To assess the effectiveness of a multiple interventionaimed at reducing antibiotic prescription rates for symptomsof the respiratory tract in primary care.

Design Randomised controlled trial.

Subjects Twelve peer review groups including 100 general practitionerswith their collaborating pharmacists in the region of Utrecht,Netherlands.

Intervention The intervention consisted of group education meetings,with a consensus procedure on indication for and type of antibioticsand with training in communication skills; monitoring and feedbackon prescribing behaviour; group education for assistants ofgeneral practitioners and pharmacists; and education materialfor patients. The control group did not receive any of theseelements.

Main outcome measures Antibiotic prescription rates for acutesymptoms of the respiratory tract and patients' satisfaction.

Results 89 general practitioners completed the study (89%).At baseline, prescription rates for antibiotics for respiratorytract symptoms did not differ between intervention and controlgroup (27% v 29%, respectively). After nine months, the prescriptionrates in the intervention group fell to 23%, whereas the controlgroup's rose to 37% (mean difference in change -12%, 95% confidenceinterval -18.9% to -4.0%). Multilevel analysis confirmed theresults of the unadjusted analysis (intervention effect -10.7%,-20.3% to -1.0%). Patients' satisfaction was high and did notdiffer in the two groups at baseline or after the intervention.

Conclusions A multiple intervention reduced prescribing ratesof antibiotics for respiratory tract symptoms while maintaininga high degree of satisfaction among patients. Further researchshould focus on the sustainability and cost effectiveness ofthis intervention.

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Penicillin is the Treatment of Choice in Most Respiratory Infections.: Friedrich Flachsbart
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When is a randomised trial a randomised trial?: Stephen J Conaty
bmj.com, 25 Aug 2004 [Full text]
The experimental unit is wrong: J Martin Bland
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Re: Penicillin is the Treatment of Choice in Most Respiratory Infections.: Ineke Welschen, et al.
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Reply to Dr Stephen J Conaty. When is a randomised trial a randomised trial?: Ineke Welschen, et al.
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Re: The experimental unit is wrong: Ineke Welschen, et al.
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