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Effects of primary care antimicrobial stewardship outreach on antibiotic use by general practice staff: pragmatic randomized controlled trial of the TARGET antibiotics workshop

OBJECTIVES: To determine whether local trainer-led TARGET antibiotic interactive workshops improve antibiotic dispensing in general practice. METHODS: Using a McNulty–Zelen-design randomized controlled trial within three regions of England, 152 general practices were stratified by clinical commissio...

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Autores principales: McNulty, Cliodna, Hawking, Meredith, Lecky, Donna, Jones, Leah, Owens, Rebecca, Charlett, André, Butler, Chris, Moore, Philippa, Francis, Nick
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5909634/
https://www.ncbi.nlm.nih.gov/pubmed/29514268
http://dx.doi.org/10.1093/jac/dky004
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author McNulty, Cliodna
Hawking, Meredith
Lecky, Donna
Jones, Leah
Owens, Rebecca
Charlett, André
Butler, Chris
Moore, Philippa
Francis, Nick
author_facet McNulty, Cliodna
Hawking, Meredith
Lecky, Donna
Jones, Leah
Owens, Rebecca
Charlett, André
Butler, Chris
Moore, Philippa
Francis, Nick
author_sort McNulty, Cliodna
collection PubMed
description OBJECTIVES: To determine whether local trainer-led TARGET antibiotic interactive workshops improve antibiotic dispensing in general practice. METHODS: Using a McNulty–Zelen-design randomized controlled trial within three regions of England, 152 general practices were stratified by clinical commissioning group, antibiotic dispensing rate and practice patient list size, then randomly allocated to intervention (offered TARGET workshop that incorporated a presentation, reflection on antibiotic data, promotion of patient and general practice (GP) staff resources, clinical scenarios and action planning, 73 practices) or control (usual practice, 79 practices). The primary outcome measure was total oral antibiotic items dispensed/1000 patients for the year after the workshop (or pseudo-workshop date for controls), adjusted for the previous year’s dispensing. RESULTS: Thirty-six (51%) intervention practices (166 GPs, 51 nurses and 101 other staff) accepted a TARGET workshop invitation. In the ITT analysis total antibiotic dispensing was 2.7% lower in intervention practices (95% CI −5.5% to 1%, P = 0.06) compared with controls. Dispensing in intervention practices was 4.4% lower for amoxicillin/ampicillin (95% CI 0.6%–8%, P = 0.02); 5.6% lower for trimethoprim (95% CI 0.7%–10.2%, P = 0.03); and a non-significant 7.1% higher for nitrofurantoin (95% CI −0.03 to 15%, P = 0.06). The Complier Average Causal Effect (CACE) analysis, which estimates impact in those that comply with assigned intervention, indicated 6.1% (95% CI 0.2%–11.7%, P = 0.04) lower total antibiotic dispensing in intervention practices and 11% (95% CI 1.6%–19.5%, P = 0.02) lower trimethoprim dispensing. CONCLUSIONS: This study within usual service provision found that TARGET antibiotic workshops can help improve antibiotic use, and therefore should be considered as part of any national antimicrobial stewardship initiatives. Additional local facilitation will be needed to encourage all general practices to participate.
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spelling pubmed-59096342018-04-24 Effects of primary care antimicrobial stewardship outreach on antibiotic use by general practice staff: pragmatic randomized controlled trial of the TARGET antibiotics workshop McNulty, Cliodna Hawking, Meredith Lecky, Donna Jones, Leah Owens, Rebecca Charlett, André Butler, Chris Moore, Philippa Francis, Nick J Antimicrob Chemother Original Research OBJECTIVES: To determine whether local trainer-led TARGET antibiotic interactive workshops improve antibiotic dispensing in general practice. METHODS: Using a McNulty–Zelen-design randomized controlled trial within three regions of England, 152 general practices were stratified by clinical commissioning group, antibiotic dispensing rate and practice patient list size, then randomly allocated to intervention (offered TARGET workshop that incorporated a presentation, reflection on antibiotic data, promotion of patient and general practice (GP) staff resources, clinical scenarios and action planning, 73 practices) or control (usual practice, 79 practices). The primary outcome measure was total oral antibiotic items dispensed/1000 patients for the year after the workshop (or pseudo-workshop date for controls), adjusted for the previous year’s dispensing. RESULTS: Thirty-six (51%) intervention practices (166 GPs, 51 nurses and 101 other staff) accepted a TARGET workshop invitation. In the ITT analysis total antibiotic dispensing was 2.7% lower in intervention practices (95% CI −5.5% to 1%, P = 0.06) compared with controls. Dispensing in intervention practices was 4.4% lower for amoxicillin/ampicillin (95% CI 0.6%–8%, P = 0.02); 5.6% lower for trimethoprim (95% CI 0.7%–10.2%, P = 0.03); and a non-significant 7.1% higher for nitrofurantoin (95% CI −0.03 to 15%, P = 0.06). The Complier Average Causal Effect (CACE) analysis, which estimates impact in those that comply with assigned intervention, indicated 6.1% (95% CI 0.2%–11.7%, P = 0.04) lower total antibiotic dispensing in intervention practices and 11% (95% CI 1.6%–19.5%, P = 0.02) lower trimethoprim dispensing. CONCLUSIONS: This study within usual service provision found that TARGET antibiotic workshops can help improve antibiotic use, and therefore should be considered as part of any national antimicrobial stewardship initiatives. Additional local facilitation will be needed to encourage all general practices to participate. Oxford University Press 2018-05 2018-03-05 /pmc/articles/PMC5909634/ /pubmed/29514268 http://dx.doi.org/10.1093/jac/dky004 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Research
McNulty, Cliodna
Hawking, Meredith
Lecky, Donna
Jones, Leah
Owens, Rebecca
Charlett, André
Butler, Chris
Moore, Philippa
Francis, Nick
Effects of primary care antimicrobial stewardship outreach on antibiotic use by general practice staff: pragmatic randomized controlled trial of the TARGET antibiotics workshop
title Effects of primary care antimicrobial stewardship outreach on antibiotic use by general practice staff: pragmatic randomized controlled trial of the TARGET antibiotics workshop
title_full Effects of primary care antimicrobial stewardship outreach on antibiotic use by general practice staff: pragmatic randomized controlled trial of the TARGET antibiotics workshop
title_fullStr Effects of primary care antimicrobial stewardship outreach on antibiotic use by general practice staff: pragmatic randomized controlled trial of the TARGET antibiotics workshop
title_full_unstemmed Effects of primary care antimicrobial stewardship outreach on antibiotic use by general practice staff: pragmatic randomized controlled trial of the TARGET antibiotics workshop
title_short Effects of primary care antimicrobial stewardship outreach on antibiotic use by general practice staff: pragmatic randomized controlled trial of the TARGET antibiotics workshop
title_sort effects of primary care antimicrobial stewardship outreach on antibiotic use by general practice staff: pragmatic randomized controlled trial of the target antibiotics workshop
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5909634/
https://www.ncbi.nlm.nih.gov/pubmed/29514268
http://dx.doi.org/10.1093/jac/dky004
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