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Reducing early career general practitioners' antibiotic prescribing for respiratory tract infections: a pragmatic prospective non-randomised controlled trial.
Magin, Parker; Tapley, Amanda; Morgan, Simon; Davis, Joshua S; McElduff, Patrick; Yardley, Lucy; Henderson, Kim; Dallas, Anthea; McArthur, Lawrie; Mulquiney, Katie; Davey, Andrew; Little, Paul; Spike, Neil; van Driel, Mieke L.
Afiliação
  • Magin P; School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
  • Tapley A; NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organization, Newcastle, Australia.
  • Morgan S; School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
  • Davis JS; NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organization, Newcastle, Australia.
  • McElduff P; Elermore Vale General Practice, Elermore Vale, Australia.
  • Yardley L; School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
  • Henderson K; Menzies School of Health Research, Royal Darwin Hospital Campus, Casuarina, Australia.
  • Dallas A; John Hunter Hospital, New Lambton Heights, Australia.
  • McArthur L; School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
  • Mulquiney K; Centre for Applications of Health Psychology, University of Southampton, Southampton, UK.
  • Davey A; School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
  • Little P; NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organization, Newcastle, Australia.
  • Spike N; University of Notre Dame, Sydney, Australia.
  • van Driel ML; Department of General Practice, University of Adelaide, Adelaide, Australia.
Fam Pract ; 35(1): 53-60, 2018 01 16.
Article em En | MEDLINE | ID: mdl-28985369
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.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecções Respiratórias / Padrões de Prática Médica / Prescrição Inadequada / Medicina Geral / Antibacterianos Tipo de estudo: Clinical_trials / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male País/Região como assunto: Oceania Idioma: En Revista: Fam Pract Ano de publicação: 2018 Tipo de documento: Article País de afiliação: Austrália

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecções Respiratórias / Padrões de Prática Médica / Prescrição Inadequada / Medicina Geral / Antibacterianos Tipo de estudo: Clinical_trials / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male País/Região como assunto: Oceania Idioma: En Revista: Fam Pract Ano de publicação: 2018 Tipo de documento: Article País de afiliação: Austrália