Antibiotic Prescribing Down 4.5 Years After Brief Training

Marcia Frellick

February 03, 2016

Prescriptions for respiratory tract infections (RTIs) were down significantly 4.5 years after a brief educational intervention for general practitioners (GPs), researchers report in an article published online January 21 in Family Practice.

RTIs are one of the most common reasons for visits to GPs, and broad-spectrum antibiotics are often prescribed, even though most cases are caused by viruses. To test whether education could reduce inappropriate prescribing, E. Ferrat, MD, MPH, from the Université Paris Est Créteil in France, and colleagues conducted a randomized controlled trial with two groups of GPs in three suburbs of Paris between September 2004 and March 2009. Among 203 GPs randomized, 168 completed the study (70 in the seminar group and 98 in the control group).

Those in the intervention group were randomly assigned either to attend a 2-day (14 hours), interactive seminar on evidence-based guidelines for diagnosing and treating upper and lower RTIs or the 2-day seminar plus 1 day of problem-solving training. During the add-on day (7 hours), GPs talked through an event that was of particular significance to them.

The authors reported previously that the seminar reduced the rate of antibiotic prescribing, compared with the physicians' preseminar rates, over the short term. Now, the authors find that the effect remained years later. After 4.5 years, changes in the primary outcome measure were −1.1% (95% confidence interval [CI], −2.2 to 0.0) in the intervention group and 1.4% (95% CI, 0.3 - 2.6) in the control group, resulting in an adjusted between-group difference of −2.2% (95% CI, −2.7 to −1.7; P < .001). The 2.2% absolute reduction is equivalent to a 16% relative reduction.

The decrease in antibiotic prescriptions was larger in the seminar-plus-problem-solving group than in the seminar group (adjusted difference, −1.1%; 95% CI, −1.9 to −0.3; P = .003).

The authors note that the intervention was not expensive: 240 euro per GP for a single 2-day seminar with or without an additional day and 300 euro per GP for compensation for lost earnings.

This study has advantages over previous work, they write. "In recent randomized trials, multifaceted interventions including educational techniques were effective in decreasing antibiotic prescriptions for RTIs and for any reason in primary care. However, these multifaceted interventions may be difficult to implement on a large scale, and none of them assessed the long-term impact of a single interactive educational seminar on GP prescribing behaviours."

The study received funding from the French National Health Insurance System, the Union des Medecins Liberaux-Ile de France, and GlaxoSmithKline.

Fam Pract. Published online January 21, 2016. Abstract

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