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Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial

Summary Background High-volume prescribing of antibiotics in primary care is a major driver of antibiotic resistance. Education of physicians and patients can lower prescribing levels, but it frequently relies on highly trained staff. We assessed whether internet-based training methods could alter p... Full description

Journal Title: Lancet 2013-10-05, Vol.382 (9899), p.1175-1182
Main Author: Little, Paul, Prof
Other Authors: Stuart, Beth, PhD , Francis, Nick, PhD , Douglas, Elaine, MSc , Tonkin-Crine, Sarah, PhD , Anthierens, Sibyl, PhD , Cals, Jochen WL, PhD , Melbye, Hasse, Prof , Santer, Miriam, PhD , Moore, Michael, FRCGP , Coenen, Samuel, Prof , Butler, Chris, Prof , Hood, Kerenza, Prof , Kelly, Mark, PhD , Godycki-Cwirko, Maciek, PhD , Mierzecki, Artur, PhD , Torres, Antoni, Prof , Llor, Carl, PhD , Davies, Melanie, MSc , Mullee, Mark, MSc , O'Reilly, Gilly, PhD , van der Velden, Alike, PhD , Geraghty, Adam WA, PhD , Goossens, Herman, Prof , Verheij, Theo, Prof , Yardley, Lucy, Prof
Format: Electronic Article Electronic Article
Language: English
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Quelle: Alma/SFX Local Collection
Publisher: Kidlington: Elsevier Ltd
ID: ISSN: 0140-6736
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recordid: cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3807804
title: Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial
format: Article
creator:
  • Little, Paul, Prof
  • Stuart, Beth, PhD
  • Francis, Nick, PhD
  • Douglas, Elaine, MSc
  • Tonkin-Crine, Sarah, PhD
  • Anthierens, Sibyl, PhD
  • Cals, Jochen WL, PhD
  • Melbye, Hasse, Prof
  • Santer, Miriam, PhD
  • Moore, Michael, FRCGP
  • Coenen, Samuel, Prof
  • Butler, Chris, Prof
  • Hood, Kerenza, Prof
  • Kelly, Mark, PhD
  • Godycki-Cwirko, Maciek, PhD
  • Mierzecki, Artur, PhD
  • Torres, Antoni, Prof
  • Llor, Carl, PhD
  • Davies, Melanie, MSc
  • Mullee, Mark, MSc
  • O'Reilly, Gilly, PhD
  • van der Velden, Alike, PhD
  • Geraghty, Adam WA, PhD
  • Goossens, Herman, Prof
  • Verheij, Theo, Prof
  • Yardley, Lucy, Prof
subjects:
  • Abridged Index Medicus
  • Acute Disease
  • Anti-Bacterial Agents - therapeutic use
  • Antibacterial agents
  • Antibiotics
  • Antibiotics. Antiinfectious agents. Antiparasitic agents
  • Articles
  • Biological and medical sciences
  • C-Reactive Protein - metabolism
  • Chronic obstructive pulmonary disease
  • Clinical Competence - standards
  • Cluster Analysis
  • Communication
  • Complications and side effects
  • Dosage and administration
  • Drug therapy
  • Ear diseases
  • Ethics
  • Europe
  • Family physicians
  • Female
  • General aspects
  • General Practice - education
  • General Practice - standards
  • Human medicine
  • Humans
  • Infections
  • Inservice Training
  • Internal Medicine
  • Internet
  • Male
  • Medical sciences
  • Middle Aged
  • Online instruction
  • Pharmacology. Drug treatments
  • Point-of-Care Systems
  • Practice Patterns, Physicians' - standards
  • Primary care
  • Primary Health Care - standards
  • Proteins
  • Respiratory tract infections
  • Respiratory Tract Infections - drug therapy
  • Teaching - methods
ispartof: Lancet, 2013-10-05, Vol.382 (9899), p.1175-1182
description: Summary Background High-volume prescribing of antibiotics in primary care is a major driver of antibiotic resistance. Education of physicians and patients can lower prescribing levels, but it frequently relies on highly trained staff. We assessed whether internet-based training methods could alter prescribing practices in multiple health-care systems. Methods After a baseline audit in October to December, 2010, primary-care practices in six European countries were cluster randomised to usual care, training in the use of a C-reactive protein (CRP) test at point of care, in enhanced communication skills, or in both CRP and enhanced communication. Patients were recruited from February to May, 2011. This trial is registered, number ISRCTN99871214. Results The baseline audit, done in 259 practices, provided data for 6771 patients with lower-respiratory-tract infections (3742 [55·3%]) and upper-respiratory-tract infections (1416 [20·9%]), of whom 5355 (79·1%) were prescribed antibiotics. After randomisation, 246 practices were included and 4264 patients were recruited. The antibiotic prescribing rate was lower with CRP training than without (33% vs 48%, adjusted risk ratio 0·54, 95% CI 0·42–0·69) and with enhanced-communication training than without (36% vs 45%, 0·69, 0·54–0·87). The combined intervention was associated with the greatest reduction in prescribing rate (CRP risk ratio 0·53, 95% CI 0·36–0·74, p
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
issn:
  • 0140-6736
  • 1474-547X
url: Link


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titleEffects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial
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creatorLittle, Paul, Prof ; Stuart, Beth, PhD ; Francis, Nick, PhD ; Douglas, Elaine, MSc ; Tonkin-Crine, Sarah, PhD ; Anthierens, Sibyl, PhD ; Cals, Jochen WL, PhD ; Melbye, Hasse, Prof ; Santer, Miriam, PhD ; Moore, Michael, FRCGP ; Coenen, Samuel, Prof ; Butler, Chris, Prof ; Hood, Kerenza, Prof ; Kelly, Mark, PhD ; Godycki-Cwirko, Maciek, PhD ; Mierzecki, Artur, PhD ; Torres, Antoni, Prof ; Llor, Carl, PhD ; Davies, Melanie, MSc ; Mullee, Mark, MSc ; O'Reilly, Gilly, PhD ; van der Velden, Alike, PhD ; Geraghty, Adam WA, PhD ; Goossens, Herman, Prof ; Verheij, Theo, Prof ; Yardley, Lucy, Prof
creatorcontribLittle, Paul, Prof ; Stuart, Beth, PhD ; Francis, Nick, PhD ; Douglas, Elaine, MSc ; Tonkin-Crine, Sarah, PhD ; Anthierens, Sibyl, PhD ; Cals, Jochen WL, PhD ; Melbye, Hasse, Prof ; Santer, Miriam, PhD ; Moore, Michael, FRCGP ; Coenen, Samuel, Prof ; Butler, Chris, Prof ; Hood, Kerenza, Prof ; Kelly, Mark, PhD ; Godycki-Cwirko, Maciek, PhD ; Mierzecki, Artur, PhD ; Torres, Antoni, Prof ; Llor, Carl, PhD ; Davies, Melanie, MSc ; Mullee, Mark, MSc ; O'Reilly, Gilly, PhD ; van der Velden, Alike, PhD ; Geraghty, Adam WA, PhD ; Goossens, Herman, Prof ; Verheij, Theo, Prof ; Yardley, Lucy, Prof ; on behalf of the GRACE consortium ; GRACE consortium
descriptionSummary Background High-volume prescribing of antibiotics in primary care is a major driver of antibiotic resistance. Education of physicians and patients can lower prescribing levels, but it frequently relies on highly trained staff. We assessed whether internet-based training methods could alter prescribing practices in multiple health-care systems. Methods After a baseline audit in October to December, 2010, primary-care practices in six European countries were cluster randomised to usual care, training in the use of a C-reactive protein (CRP) test at point of care, in enhanced communication skills, or in both CRP and enhanced communication. Patients were recruited from February to May, 2011. This trial is registered, number ISRCTN99871214. Results The baseline audit, done in 259 practices, provided data for 6771 patients with lower-respiratory-tract infections (3742 [55·3%]) and upper-respiratory-tract infections (1416 [20·9%]), of whom 5355 (79·1%) were prescribed antibiotics. After randomisation, 246 practices were included and 4264 patients were recruited. The antibiotic prescribing rate was lower with CRP training than without (33% vs 48%, adjusted risk ratio 0·54, 95% CI 0·42–0·69) and with enhanced-communication training than without (36% vs 45%, 0·69, 0·54–0·87). The combined intervention was associated with the greatest reduction in prescribing rate (CRP risk ratio 0·53, 95% CI 0·36–0·74, p<0·0001; enhanced communication 0·68, 0·50–0·89, p=0·003; combined 0·38, 0·25–0·55, p<0·0001). Interpretation Internet training achieved important reductions in antibiotic prescribing for respiratory-tract infections across language and cultural boundaries. Funding European Commission Framework Programme 6, National Institute for Health Research, Research Foundation Flanders.
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0ISSN: 0140-6736
1EISSN: 1474-547X
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languageeng
publisherKidlington: Elsevier Ltd
subjectAbridged Index Medicus ; Acute Disease ; Anti-Bacterial Agents - therapeutic use ; Antibacterial agents ; Antibiotics ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Articles ; Biological and medical sciences ; C-Reactive Protein - metabolism ; Chronic obstructive pulmonary disease ; Clinical Competence - standards ; Cluster Analysis ; Communication ; Complications and side effects ; Dosage and administration ; Drug therapy ; Ear diseases ; Ethics ; Europe ; Family physicians ; Female ; General aspects ; General Practice - education ; General Practice - standards ; Human medicine ; Humans ; Infections ; Inservice Training ; Internal Medicine ; Internet ; Male ; Medical sciences ; Middle Aged ; Online instruction ; Pharmacology. Drug treatments ; Point-of-Care Systems ; Practice Patterns, Physicians' - standards ; Primary care ; Primary Health Care - standards ; Proteins ; Respiratory tract infections ; Respiratory Tract Infections - drug therapy ; Teaching - methods
ispartofLancet, 2013-10-05, Vol.382 (9899), p.1175-1182
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72013 Elsevier Ltd. All rights reserved. 2013 Elsevier Ltd
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2Francis, Nick, PhD
3Douglas, Elaine, MSc
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5Anthierens, Sibyl, PhD
6Cals, Jochen WL, PhD
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9Moore, Michael, FRCGP
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11Butler, Chris, Prof
12Hood, Kerenza, Prof
13Kelly, Mark, PhD
14Godycki-Cwirko, Maciek, PhD
15Mierzecki, Artur, PhD
16Torres, Antoni, Prof
17Llor, Carl, PhD
18Davies, Melanie, MSc
19Mullee, Mark, MSc
20O'Reilly, Gilly, PhD
21van der Velden, Alike, PhD
22Geraghty, Adam WA, PhD
23Goossens, Herman, Prof
24Verheij, Theo, Prof
25Yardley, Lucy, Prof
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descriptionSummary Background High-volume prescribing of antibiotics in primary care is a major driver of antibiotic resistance. Education of physicians and patients can lower prescribing levels, but it frequently relies on highly trained staff. We assessed whether internet-based training methods could alter prescribing practices in multiple health-care systems. Methods After a baseline audit in October to December, 2010, primary-care practices in six European countries were cluster randomised to usual care, training in the use of a C-reactive protein (CRP) test at point of care, in enhanced communication skills, or in both CRP and enhanced communication. Patients were recruited from February to May, 2011. This trial is registered, number ISRCTN99871214. Results The baseline audit, done in 259 practices, provided data for 6771 patients with lower-respiratory-tract infections (3742 [55·3%]) and upper-respiratory-tract infections (1416 [20·9%]), of whom 5355 (79·1%) were prescribed antibiotics. After randomisation, 246 practices were included and 4264 patients were recruited. The antibiotic prescribing rate was lower with CRP training than without (33% vs 48%, adjusted risk ratio 0·54, 95% CI 0·42–0·69) and with enhanced-communication training than without (36% vs 45%, 0·69, 0·54–0·87). The combined intervention was associated with the greatest reduction in prescribing rate (CRP risk ratio 0·53, 95% CI 0·36–0·74, p<0·0001; enhanced communication 0·68, 0·50–0·89, p=0·003; combined 0·38, 0·25–0·55, p<0·0001). Interpretation Internet training achieved important reductions in antibiotic prescribing for respiratory-tract infections across language and cultural boundaries. Funding European Commission Framework Programme 6, National Institute for Health Research, Research Foundation Flanders.
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1Acute Disease
2Anti-Bacterial Agents - therapeutic use
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24Human medicine
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26Infections
27Inservice Training
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36Practice Patterns, Physicians' - standards
37Primary care
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titleEffects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial
authorLittle, Paul, Prof ; Stuart, Beth, PhD ; Francis, Nick, PhD ; Douglas, Elaine, MSc ; Tonkin-Crine, Sarah, PhD ; Anthierens, Sibyl, PhD ; Cals, Jochen WL, PhD ; Melbye, Hasse, Prof ; Santer, Miriam, PhD ; Moore, Michael, FRCGP ; Coenen, Samuel, Prof ; Butler, Chris, Prof ; Hood, Kerenza, Prof ; Kelly, Mark, PhD ; Godycki-Cwirko, Maciek, PhD ; Mierzecki, Artur, PhD ; Torres, Antoni, Prof ; Llor, Carl, PhD ; Davies, Melanie, MSc ; Mullee, Mark, MSc ; O'Reilly, Gilly, PhD ; van der Velden, Alike, PhD ; Geraghty, Adam WA, PhD ; Goossens, Herman, Prof ; Verheij, Theo, Prof ; Yardley, Lucy, Prof
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35Point-of-Care Systems
36Practice Patterns, Physicians' - standards
37Primary care
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39Proteins
40Respiratory tract infections
41Respiratory Tract Infections - drug therapy
42Teaching - methods
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81Risk Abstracts
82Safety Science and Risk
83OpenAIRE
84OpenAIRE (Open Access)
85PubMed Central (Full Participant titles)
jtitleLancet
delivery
delcategoryRemote Search Resource
fulltextfulltext
addata
au
0Little, Paul, Prof
1Stuart, Beth, PhD
2Francis, Nick, PhD
3Douglas, Elaine, MSc
4Tonkin-Crine, Sarah, PhD
5Anthierens, Sibyl, PhD
6Cals, Jochen WL, PhD
7Melbye, Hasse, Prof
8Santer, Miriam, PhD
9Moore, Michael, FRCGP
10Coenen, Samuel, Prof
11Butler, Chris, Prof
12Hood, Kerenza, Prof
13Kelly, Mark, PhD
14Godycki-Cwirko, Maciek, PhD
15Mierzecki, Artur, PhD
16Torres, Antoni, Prof
17Llor, Carl, PhD
18Davies, Melanie, MSc
19Mullee, Mark, MSc
20O'Reilly, Gilly, PhD
21van der Velden, Alike, PhD
22Geraghty, Adam WA, PhD
23Goossens, Herman, Prof
24Verheij, Theo, Prof
25Yardley, Lucy, Prof
aucorp
0on behalf of the GRACE consortium
1GRACE consortium
formatjournal
genrearticle
ristypeJOUR
atitleEffects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial
jtitleLancet
addtitleLancet
date2013-10-05
risdate2013
volume382
issue9899
spage1175
epage1182
pages1175-1182
issn0140-6736
eissn1474-547X
codenLANCAO
abstractSummary Background High-volume prescribing of antibiotics in primary care is a major driver of antibiotic resistance. Education of physicians and patients can lower prescribing levels, but it frequently relies on highly trained staff. We assessed whether internet-based training methods could alter prescribing practices in multiple health-care systems. Methods After a baseline audit in October to December, 2010, primary-care practices in six European countries were cluster randomised to usual care, training in the use of a C-reactive protein (CRP) test at point of care, in enhanced communication skills, or in both CRP and enhanced communication. Patients were recruited from February to May, 2011. This trial is registered, number ISRCTN99871214. Results The baseline audit, done in 259 practices, provided data for 6771 patients with lower-respiratory-tract infections (3742 [55·3%]) and upper-respiratory-tract infections (1416 [20·9%]), of whom 5355 (79·1%) were prescribed antibiotics. After randomisation, 246 practices were included and 4264 patients were recruited. The antibiotic prescribing rate was lower with CRP training than without (33% vs 48%, adjusted risk ratio 0·54, 95% CI 0·42–0·69) and with enhanced-communication training than without (36% vs 45%, 0·69, 0·54–0·87). The combined intervention was associated with the greatest reduction in prescribing rate (CRP risk ratio 0·53, 95% CI 0·36–0·74, p<0·0001; enhanced communication 0·68, 0·50–0·89, p=0·003; combined 0·38, 0·25–0·55, p<0·0001). Interpretation Internet training achieved important reductions in antibiotic prescribing for respiratory-tract infections across language and cultural boundaries. Funding European Commission Framework Programme 6, National Institute for Health Research, Research Foundation Flanders.
copKidlington
pubElsevier Ltd
pmid23915885
doi10.1016/S0140-6736(13)60994-0
oafree_for_read