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Impact of a multifaceted intervention to improve antibiotic prescribing: a pragmatic cluster-randomised controlled trial
OBJECTIVES: This study sought to assess the effectiveness and return on investment (ROI) of a multifaceted intervention aimed at improving antibiotic prescribing for acute respiratory infections in primary care. DESIGN: Large-sized, two-arm, open-label, pragmatic, cluster-randomised controlled trial...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722452/ https://www.ncbi.nlm.nih.gov/pubmed/33287881 http://dx.doi.org/10.1186/s13756-020-00857-9 |
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author | Figueiras, Adolfo López-Vázquez, Paula Gonzalez-Gonzalez, Cristian Vázquez-Lago, Juan Manuel Piñeiro-Lamas, María López-Durán, Ana Sánchez, Coro Herdeiro, María Teresa Zapata-Cachafeiro, Maruxa |
author_facet | Figueiras, Adolfo López-Vázquez, Paula Gonzalez-Gonzalez, Cristian Vázquez-Lago, Juan Manuel Piñeiro-Lamas, María López-Durán, Ana Sánchez, Coro Herdeiro, María Teresa Zapata-Cachafeiro, Maruxa |
author_sort | Figueiras, Adolfo |
collection | PubMed |
description | OBJECTIVES: This study sought to assess the effectiveness and return on investment (ROI) of a multifaceted intervention aimed at improving antibiotic prescribing for acute respiratory infections in primary care. DESIGN: Large-sized, two-arm, open-label, pragmatic, cluster-randomised controlled trial. SETTING: All primary care physicians working for the Spanish National Health Service (NHS) in Galicia (region in north-west Spain). PARTICIPANTS: The seven spatial clusters were distributed by unequal randomisation (3:4) of the intervention and control groups. A total of 1217 physicians (1.30 million patients) were recruited from intervention clusters and 1393 physicians (1.46 million patients) from control clusters. INTERVENTIONS: One-hour educational outreach visits tailored to training needs identified in a previous study; an online course integrated in practice accreditation; and a clinical decision support system. MAIN OUTCOME MEASURES: Changes in the ESAC (European Surveillance of Antimicrobial Consumption) quality indicators for outpatient antibiotic use. We used generalised linear mixed and conducted a ROI analysis to ascertain the overall cost savings. RESULTS: Median follow-up was 19 months. The adjusted effect on overall antibiotic prescribing attributable to the intervention was − 4.2% (95% CI: − 5.3% to − 3.2%), with this being more pronounced for penicillins − 6.5 (95% CI: − 7.9% to − 5.2%) and for the ratio of consumption of broad- to narrow-spectrum penicillins, cephalosporins, and macrolides − 9.0% (95% CI: − 14.0 to − 4.1%). The cost of the intervention was €87 per physician. Direct savings per physician attributable to the reduction in antibiotic prescriptions was €311 for the NHS and €573 for patient contributions, with an ROI of €2.57 and €5.59 respectively. CONCLUSIONS: Interventions designed on the basis of gaps in physicians’ knowledge of and attitudes to misprescription can improve antibiotic prescribing and yield important direct cost savings. Trial registration: Current Controlled Trials ISRCTN24158380. Registered 5 February 2009. |
format | Online Article Text |
id | pubmed-7722452 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-77224522020-12-08 Impact of a multifaceted intervention to improve antibiotic prescribing: a pragmatic cluster-randomised controlled trial Figueiras, Adolfo López-Vázquez, Paula Gonzalez-Gonzalez, Cristian Vázquez-Lago, Juan Manuel Piñeiro-Lamas, María López-Durán, Ana Sánchez, Coro Herdeiro, María Teresa Zapata-Cachafeiro, Maruxa Antimicrob Resist Infect Control Research OBJECTIVES: This study sought to assess the effectiveness and return on investment (ROI) of a multifaceted intervention aimed at improving antibiotic prescribing for acute respiratory infections in primary care. DESIGN: Large-sized, two-arm, open-label, pragmatic, cluster-randomised controlled trial. SETTING: All primary care physicians working for the Spanish National Health Service (NHS) in Galicia (region in north-west Spain). PARTICIPANTS: The seven spatial clusters were distributed by unequal randomisation (3:4) of the intervention and control groups. A total of 1217 physicians (1.30 million patients) were recruited from intervention clusters and 1393 physicians (1.46 million patients) from control clusters. INTERVENTIONS: One-hour educational outreach visits tailored to training needs identified in a previous study; an online course integrated in practice accreditation; and a clinical decision support system. MAIN OUTCOME MEASURES: Changes in the ESAC (European Surveillance of Antimicrobial Consumption) quality indicators for outpatient antibiotic use. We used generalised linear mixed and conducted a ROI analysis to ascertain the overall cost savings. RESULTS: Median follow-up was 19 months. The adjusted effect on overall antibiotic prescribing attributable to the intervention was − 4.2% (95% CI: − 5.3% to − 3.2%), with this being more pronounced for penicillins − 6.5 (95% CI: − 7.9% to − 5.2%) and for the ratio of consumption of broad- to narrow-spectrum penicillins, cephalosporins, and macrolides − 9.0% (95% CI: − 14.0 to − 4.1%). The cost of the intervention was €87 per physician. Direct savings per physician attributable to the reduction in antibiotic prescriptions was €311 for the NHS and €573 for patient contributions, with an ROI of €2.57 and €5.59 respectively. CONCLUSIONS: Interventions designed on the basis of gaps in physicians’ knowledge of and attitudes to misprescription can improve antibiotic prescribing and yield important direct cost savings. Trial registration: Current Controlled Trials ISRCTN24158380. Registered 5 February 2009. BioMed Central 2020-12-07 /pmc/articles/PMC7722452/ /pubmed/33287881 http://dx.doi.org/10.1186/s13756-020-00857-9 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Figueiras, Adolfo López-Vázquez, Paula Gonzalez-Gonzalez, Cristian Vázquez-Lago, Juan Manuel Piñeiro-Lamas, María López-Durán, Ana Sánchez, Coro Herdeiro, María Teresa Zapata-Cachafeiro, Maruxa Impact of a multifaceted intervention to improve antibiotic prescribing: a pragmatic cluster-randomised controlled trial |
title | Impact of a multifaceted intervention to improve antibiotic prescribing: a pragmatic cluster-randomised controlled trial |
title_full | Impact of a multifaceted intervention to improve antibiotic prescribing: a pragmatic cluster-randomised controlled trial |
title_fullStr | Impact of a multifaceted intervention to improve antibiotic prescribing: a pragmatic cluster-randomised controlled trial |
title_full_unstemmed | Impact of a multifaceted intervention to improve antibiotic prescribing: a pragmatic cluster-randomised controlled trial |
title_short | Impact of a multifaceted intervention to improve antibiotic prescribing: a pragmatic cluster-randomised controlled trial |
title_sort | impact of a multifaceted intervention to improve antibiotic prescribing: a pragmatic cluster-randomised controlled trial |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722452/ https://www.ncbi.nlm.nih.gov/pubmed/33287881 http://dx.doi.org/10.1186/s13756-020-00857-9 |
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