BMJ, 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 1, Marijke M Kuyvenhoven 1, Arno W Hoes 1, Theo J M Verheij 1

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

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

Design Randomised controlled trial.

Subjects Twelve peer review groups including 100 general practitioners with 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 antibiotics and with training in communication skills; monitoring and feedback on prescribing behaviour; group education for assistants of general practitioners and pharmacists; and education material for patients. The control group did not receive any of these elements.

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

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

Conclusions A multiple intervention reduced prescribing rates of antibiotics for respiratory tract symptoms while maintaining a high degree of satisfaction among patients. Further research should focus on the sustainability and cost effectiveness of this intervention.

(Accepted 14 June 2004)
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Rapid Responses:

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Penicillin is the Treatment of Choice in Most Respiratory Infections.
Friedrich Flachsbart
bmj.com, 23 Aug 2004 [Full text]
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
bmj.com, 27 Aug 2004 [Full text]
Re: Penicillin is the Treatment of Choice in Most Respiratory Infections.
Ineke Welschen, et al.
bmj.com, 11 Sep 2004 [Full text]
Reply to Dr Stephen J Conaty. When is a randomised trial a randomised trial?
Ineke Welschen, et al.
bmj.com, 11 Sep 2004 [Full text]
Re: The experimental unit is wrong
Ineke Welschen, et al.
bmj.com, 14 Sep 2004 [Full text]
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