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Primary Care

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

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.38182.591238.EB (Published 19 August 2004) Cite this as: BMJ 2004;329:431
  1. Ineke Welschen, junior researcher (i.welschen{at}med.uu.nl)1,
  2. Marijke M Kuyvenhoven, associate professor1,
  3. Arno W Hoes, professor of clinical epidemiology1,
  4. Theo J M Verheij, professor of general practice1
  1. 1 University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, PO Box 85060, 3508 AB Utrecht, Netherlands
  1. Correspondence to: I. Welschen
  • Accepted 14 June 2004

Abstract

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 educational 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.

Footnotes

  • We thank the general practitioners and their patients who participated in this study and our data managers, P Zuithoff and F Verheij, for their help with data processing and analyses. We also want to thank the Municipal Health Service of Utrecht and the Dutch Institute for Rational Drug Use (DGV Nederlands Instituut voor Verantwoord Medicijngebruik) for their co-operation with the development of the intervention. We thank the regional health insurance company (Agis) for supply of the claims data.

  • Contributors MK, AH, and TV conceived the study and developed the protocol. IW, MK, AH, and TV collected data, managed the study, and wrote and interpreted the report. MK is guarantor.

  • Funding Netherlands Organisation for Health Research and Development (Zorg Onderzoek Nederland) project number 2200.0057 and Foundation for the Advancement of Appropriate Prescription Drug Usage in the Central Region of the Netherlands (Stichting Doelmatig Geneesmiddelengebruik Midden Nederland).

  • Competing interests None declared.

  • Ethical approval Research Ethics Committee of the University Medical Center (UMC) Utrecht.

  • Accepted 14 June 2004
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