TY - JOUR
T1 - Antibiotic Prescribing for Acute Respiratory Tract Infections 12 Months After Communication and CRP Training
T2 - A Randomized Trial
AU - Little, Paul
AU - Stuart, Beth
AU - Francis, Nick
AU - Douglas, Elaine
AU - Tonkin-Crine, Sarah
AU - Anthierens, Sibyl
AU - Cals, Jochen W. L.
AU - Melbye, Hasse
AU - Santer, Miriam
AU - Moore, Michael
AU - Coenen, Samuel
AU - Butler, Chris C.
AU - Hood, Kerenza
AU - Kelson, Mark
AU - Godycki-Cwirko, Maciek
AU - Mierzecki, Artur
AU - Torres, Antoni
AU - Llor, Carl
AU - Davies, Melanie
AU - Mullee, Mark
AU - O'Reilly, Gilly
AU - van der Velden, Alike
AU - Geraghty, Adam W. A.
AU - Goossens, Herman
AU - Verheij, Theo
AU - Yardley, Lucy
AU - GRACE consortium
N1 - Funding Information:
The work reported as part of the final follow-up was also supported through the European Science Foundation (ESF), in the framework of the Research Networking Programme TRACE (www.esf.org/trace). Contributors to this programme: Bond University (Australia); Research Foundation–Flanders, University of Antwerp, University of Ghent (Belgium); Chinese University of Hong Kong (China); University of Copenhagen (Denmark); Research Council of Health, Academy of Finland (Finland); College Azuréen des Généralistes Enseignants, Comité Départemental d’Education pour la Santé (France); Rostock University (Germany); The Netherlands Organisation for Scientific Research, AMC Amsterdam, Leiden UMC, UMC Utrecht (The Netherlands); Research Council of Norway, University of Oslo, University of Tromso (Norway); Medical University of Bialystok, Medical University of Lodz (Poland); National University Research Council (Romania); Osnovno zdravstvo Gorenjske (Slovenia); l’Institut d’Investigacions Biomèdiques August Pi i Sunyer (Spain); Swedish Research Council, Karolinska Institute (Sweden); Medical Research Council, Cardiff University, University of Oxford, University of Southampton (United Kingdom); Swiss National Science Foundation (Switzerland).
Funding Information:
Funding support: The research performed by the GRACE (Genomics to combat Resistance against Antibiotics in Community-acquired LRTI in Europe) consortium leading to these results was funded by the European Community’s Sixth Framework Programme under grant agreement no. 518226. The work in the United Kingdom was also supported by the National Institute for Health Research (NIHR) (service support costs) and by the Research Foundation–Flanders (G.0274.08N). Orion Diag-nostica supplied all the equipment and consumables for CRP testing.
Funding Information:
The research performed by the GRACE (Genomics to combat Resistance against Antibiotics in Community-acquired LRTI in Europe) consortium leading to these results was funded by the European Community’s Sixth Framework Programme under grant agreement no. 518226. The work in the United Kingdom was also supported by the National Institute for Health Research (NIHR) (service support costs) and by the Research Foundation–Flanders (G.0274.08N). Orion Diag-nostica supplied all the equipment and consumables for CRP testing.The work reported as part of the final follow-up was also supported through the European Science Foundation (ESF), in the framework of the Research Networking Programme TRACE (www.esf.org/trace). Contributors to this programme: Bond University (Australia); Research Foundation–Flanders, University of Antwerp, University of Ghent (Belgium); Chinese University of Hong Kong (China); University of Copenhagen (Denmark); Research Council of Health, Academy of Finland (Finland); College Azuréen des Généralistes Enseignants, Comité Départemental d’Education pour la Santé (France); Rostock University (Germany); The Netherlands Organisation for Scientific Research, AMC Amsterdam, Leiden UMC, UMC Utrecht (The Netherlands); Research Council of Norway, University of Oslo, University of Tromso (Norway); Medical University of Bialystok, Medical University of Lodz (Poland); National University Research Council (Romania); Osnovno zdravstvo Gorenjske (Slovenia); l’Institut d’Investigacions Biomèdiques August Pi i Sunyer (Spain); Swedish Research Council, Karolinska Institute (Sweden); Medical Research Council, Cardiff University, University of Oxford, University of Southampton (United Kingdom); Swiss National Science Foundation (Switzerland).
Publisher Copyright:
© 2019, Annals of Family Medicine, Inc. All rights reserved.
PY - 2019
Y1 - 2019
N2 - PURPOSE C-reactive-protein (CRP) is useful for diagnosis of lower respiratory tract infections (RTIs). A large international trial documented that Internet-based training in CRP point-of-care testing, in enhanced communication skills, or both reduced antibiotic prescribing at 3 months, with risk ratios (RRs) of 0.68, 0.53, 0.38, respectively. We report the longer-term impact in this trial.METHODS A total of 246 general practices in 6 countries were cluster-randomized to usual care, Internet-based training on CRP point-of-care testing, Internet-based training on enhanced communication skills and interactive booklet, or both interventions combined. The main outcome was antibiotic prescribing for RTIs after 12 months.RESULTS Of 228 practices providing 3-month data, 74% provided 12-month data, with no demonstrable attrition bias. Between 3 months and 12 months, prescribing for RTIs decreased with usual care (from 58% to 51%), but increased with CRP training (from 35% to 43%) and with both interventions combined (from 32% to 45%); at 12 months, the adjusted RRs compared with usual care were 0.75 (95% CI, 0.51-1.00) and 0.70 (95% CI, 0.49-0.93), respectively. Between 3 months and 12 months, the reduction in prescribing with communication training was maintained (41% and 40%, with an RR at 12 months of 0.70 [95% CI, 0.49-0.94]). Although materials were provided for free, clinicians seldom used booklets and rarely used CRP point-of-care testing. Communication training, but not CRP training, remained efficacious for reducing prescribing for lower RTIs (RR = 0.7195% CI, 0.45-0.99, and RR = 0.76; 95% CI, 0.47-1.06, respectively), whereas both remained efficacious for reducing prescribing for upper RTIs (RR = 0.60; 95% CI, 0.37-0.94, and RR = 0.58; 95% CI, 0.36-0.92, respectively).CONCLUSIONS Internet-based training in enhanced communication skills remains effective in the longer term for reducing antibiotic prescribing. The early improvement seen with CRP training wanes, and this training becomes ineffective for lower RTIs, the only current indication for using CRP testing.
AB - PURPOSE C-reactive-protein (CRP) is useful for diagnosis of lower respiratory tract infections (RTIs). A large international trial documented that Internet-based training in CRP point-of-care testing, in enhanced communication skills, or both reduced antibiotic prescribing at 3 months, with risk ratios (RRs) of 0.68, 0.53, 0.38, respectively. We report the longer-term impact in this trial.METHODS A total of 246 general practices in 6 countries were cluster-randomized to usual care, Internet-based training on CRP point-of-care testing, Internet-based training on enhanced communication skills and interactive booklet, or both interventions combined. The main outcome was antibiotic prescribing for RTIs after 12 months.RESULTS Of 228 practices providing 3-month data, 74% provided 12-month data, with no demonstrable attrition bias. Between 3 months and 12 months, prescribing for RTIs decreased with usual care (from 58% to 51%), but increased with CRP training (from 35% to 43%) and with both interventions combined (from 32% to 45%); at 12 months, the adjusted RRs compared with usual care were 0.75 (95% CI, 0.51-1.00) and 0.70 (95% CI, 0.49-0.93), respectively. Between 3 months and 12 months, the reduction in prescribing with communication training was maintained (41% and 40%, with an RR at 12 months of 0.70 [95% CI, 0.49-0.94]). Although materials were provided for free, clinicians seldom used booklets and rarely used CRP point-of-care testing. Communication training, but not CRP training, remained efficacious for reducing prescribing for lower RTIs (RR = 0.7195% CI, 0.45-0.99, and RR = 0.76; 95% CI, 0.47-1.06, respectively), whereas both remained efficacious for reducing prescribing for upper RTIs (RR = 0.60; 95% CI, 0.37-0.94, and RR = 0.58; 95% CI, 0.36-0.92, respectively).CONCLUSIONS Internet-based training in enhanced communication skills remains effective in the longer term for reducing antibiotic prescribing. The early improvement seen with CRP training wanes, and this training becomes ineffective for lower RTIs, the only current indication for using CRP testing.
KW - C-reactive protein
KW - CLUSTER
KW - COHORT
KW - COUGH
KW - GENERAL-PRACTICE
KW - PRIMARY-CARE
KW - STRATEGIES
KW - antibiotics
KW - antimicrobial resistance
KW - antimicrobial stewardship
KW - clinical practice patterns
KW - communication
KW - practice-based research
KW - prescribing
KW - primary care
KW - respiratory tract infections
U2 - 10.1370/afm.2356
DO - 10.1370/afm.2356
M3 - Article
SN - 1544-1709
VL - 17
SP - 125
EP - 132
JO - Annals of Family Medicine
JF - Annals of Family Medicine
IS - 2
ER -