scholarly journals Performance associated effect variations of public reporting in promoting antibiotic prescribing practice: a cluster randomized-controlled trial in primary healthcare settings

2017 ◽  
Vol 18 (05) ◽  
pp. 482-491 ◽  
Author(s):  
Yuqing Tang ◽  
Chenxi Liu ◽  
Xinping Zhang
Keyword(s):  
Randomized Controlled Trial ◽  
Primary Healthcare ◽  
Antibiotic Prescription ◽  
Controlled Trial ◽  
Public Reporting ◽  
Antibiotic Prescribing ◽  
Randomized Controlled ◽  
Healthcare Settings ◽  
Prescribing Practice ◽  
Cluster Randomized

Aim To evaluate the variations in effect of public reporting in antibiotic prescribing practice among physicians with different performance in primary healthcare settings. Background Overprovision of antibiotics is a major public health concern. Public reporting has been adopted to encourage good antibiotic prescribing practices. However, which group, for instance, high, average or low antibiotic prescribers, accounted for antibiotic prescription reduction has not been fully understood. Methods A cluster randomized-controlled trial was conducted. In total, 20 primary healthcare institutions in Qianjiang city were paired through a six indicators-synthesized score. Coin flipping was used to assign control–intervention status; 10 were then subjected to intervention where prescription indicators were publicly reported monthly over a one-year period. Prescriptions for upper respiratory tract infections (URTIs) before and after the intervention were collected. Physicians were divided into high, average and low antibiotic prescribers based on their antibiotic prescribing rates last month, which were publicly reported in intervention arm. Multilevel difference-in-differences logit regressions were performed to estimate intervention effect in each physician group on three outcome indicators: prescriptions containing antibiotics, two or more antibiotics and antibiotic injections. Findings In total, 31 460 URTI prescriptions were collected (16 170 in intervention arm and 15 290 in control arm). Reduction in antibiotic prescription attributed to intervention was 2.82% [95% confidence intervals (CI): −4.09, −1.54%, P<0.001], least significant in low prescribers (−1.41%, 95% CI: −3.81, 0.99%, P=0.249) and most significant in average prescribers (−5.01%, 95% CI: −6.94, −3.07%, P<0.001). Reduction in combined antibiotics prescriptions attributed to intervention was 3.81% (95% CI: −5.23, −2.39%, P<0.001), least significant in low prescribers (−2.42%, 95% CI: −4.39, −0.45%, P=0.016) and most significant in average prescribers (−5.01%, 95% CI: −7.47, −2.56%, P<0.001). Conclusion Public reporting can positively influence antibiotic prescribing patterns of physicians for URTIs in primary care settings, with reduction in antibiotic and combined antibiotic prescriptions. The reduction was mainly attributed to average and high antibiotic prescribers.

Understanding factors influencing antibiotic prescribing behaviour in rural China: a qualitative process evaluation of a cluster randomized controlled trial

2020 ◽  
Vol 25 (2) ◽  
pp. 94-103 ◽  
Author(s):  
Xiaolin Wei ◽  
Simin Deng ◽  
Victoria Haldane ◽  
Claire Blacklock ◽  
Wei Zhang ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Peer Review ◽  
Process Evaluation ◽  
Controlled Trial ◽  
Cluster Randomized Controlled Trial ◽  
Antibiotic Prescribing ◽  
Randomized Controlled ◽  
Qualitative Process Evaluation ◽  
Cluster Randomized ◽  
Tract Infections

Objectives We conducted a qualitative process evaluation embedded in a cluster randomized controlled trial in rural Guangxi China, which successfully reduced antibiotic use for children upper respiratory tract infections. This study aims to report on the factors that influenced behaviour change among providers and caregivers in the intervention arm, and to explore contextual considerations which may have influenced trial outcomes. Methods A total of 35 in-depth interviews were carried out with hospital directors, doctors, and caregivers of children. Participants were recruited from six purposively selected facilities, including two higher performing and two lower performing facilities per trial results. Interviews were conducted in Chinese and translated to English. We also observed guideline training sessions and prescription peer review meetings. Data were analysed using framework analysis. Results Intervention-arm doctors described that training sessions improved their knowledge, skills and confidence in appropriate prescribing. This was contrasted by control arm participants who did not receive training and reported less agency in reducing prescribing rates. Prescription peer review meetings were seen as an opportunity for further education, action planning and goal setting, particularly in high performing hospitals, where these meetings were led by senior doctors who were perceived to have relevant clinical experience. Caregiver participants reported that intervention educational materials were helpful but they identified information from doctors was more useful. Providers and caregivers also described contextual health system factors, including hospital competition, short consultation times, and antibiotic availability without prescription, which shaped care preferences. Conclusions This qualitative process evaluation identified a range of factors that may have influenced behaviour among providers and caregivers leading to observed changes in reducing inappropriate antibiotic prescribing in China. Future interventions to reduce antibiotic prescribing should consider system level and wider contextual factors to better understand behaviours and patient care preferences.

scholarly journals Reducing Antibiotic Prescriptions for Urinary Tract Infection in Nursing Homes Using a Complex Tailored Intervention Targeting Nursing Home Staff: Protocol for a Cluster Randomized Controlled Trial (Preprint)

2020 ◽  
Author(s):  
Sif Helene Arnold ◽  
Jette Nygaard Jensen ◽  
Marius Brostrøm Kousgaard ◽  
Volkert Siersma ◽  
Lars Bjerrum ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Nursing Home ◽  
Nursing Homes ◽  
Antibiotic Prescription ◽  
Controlled Trial ◽  
Nursing Home Residents ◽  
Cluster Randomized Controlled Trial ◽  
Nursing Home Staff ◽  
Randomized Controlled ◽  
Cluster Randomized

BACKGROUND Urinary tract infection (UTI) is the most common reason for antibiotic prescription in nursing homes. Overprescription causes antibiotic-related harms in those who are treated and others residing within the nursing home. The diagnostic process in nursing homes is complicated with both challenging issues related to the elderly population and the nursing home setting. A physician rarely visits a nursing home for suspected UTI. Consequently, the knowledge of UTI and communication skills of staff influence the diagnosis. OBJECTIVE The objective of this study is to describe a cluster randomized controlled trial with a tailored complex intervention for improving the knowledge of UTI and communication skills of nursing home staff in order to decrease the number of antibiotic prescriptions for UTI in nursing home residents, without changing hospitalization and mortality. METHODS The study describes an open-label cluster randomized controlled trial with two parallel groups and a 1:1 allocation ratio. Twenty-two eligible nursing homes are sampled from the Capital Region of Denmark, corresponding to 1274 nursing home residents. The intervention group receives a dialogue tool, and all nursing home staff attend a workshop on UTI. The main outcomes of the study are the antibiotic prescription rate for UTI, all-cause hospitalization, all-cause mortality, and suspected UTI during the trial period. RESULTS The trial ended in April 2019. Data have been collected and are being analyzed. We expect the results of the trial to be published in a peer-reviewed journal in the fall of 2020. CONCLUSIONS The greatest strengths of this study are the randomized design, tailored development of the intervention, and access to medical records. The potential limitations are the hierarchy in the prescription process, Hawthorne effect, and biased access to data on signs and symptoms through a UTI diary. The results of this trial could offer a strategy to overcome some of the challenges of increased antibiotic resistance and could have implications in terms of how to handle cases of suspected UTI. CLINICALTRIAL ClinicalTrials.gov NCT03715062; https://clinicaltrials.gov/ct2/show/NCT03715062 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/17710

scholarly journals Prescriber Commitment Posters to Increase Prudent Antibiotic Prescribing in English General Practice: A Cluster Randomized Controlled Trial

Antibiotics ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. 490
Author(s):  
Anna Sallis ◽  
Paulina Bondaronek ◽  
Jet G. Sanders ◽  
Ly-Mee Yu ◽  
Victoria Harris ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Usual Care ◽  
Antimicrobial Stewardship ◽  
Controlled Trial ◽  
Cluster Randomized Controlled Trial ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
Randomized Controlled ◽  
Cluster Randomized ◽  
Tract Infections

Unnecessary antibiotic prescribing contributes to Antimicrobial Resistance posing a major public health risk. Estimates suggest as many as half of antibiotics prescribed for respiratory infections may be unnecessary. We conducted a three-armed unblinded cluster randomized controlled trial (ISRCTN trial registry 83322985). Interventions were a commitment poster (CP) advocating safe antibiotic prescribing or a CP plus an antimicrobial stewardship message (AM) on telephone appointment booking lines, tested against a usual care control group. The primary outcome measure was antibiotic item dispensing rates per 1000 population adjusted for practice demographics. The outcome measures for post-hoc analysis were dispensing rates of antibiotics usually prescribed for upper respiratory tract infections and broad spectrum antibiotics. In total, 196 practice units were randomized to usual care (n = 60), CP (n = 66), and CP&AM (n = 70). There was no effect on the overall dispensing rates for either interventions compared to usual care (CP 5.673, 95%CI −9.768 to 21.113, p = 0.458; CP&AM, −12.575, 95%CI −30.726 to 5.576, p = 0.167). Secondary analysis, which included pooling the data into one model, showed a significant effect of the AM (−18.444, 95%CI −32.596 to −4.292, p = 0.012). Fewer penicillins and macrolides were prescribed in the CP&AM intervention compared to usual care (−12.996, 95% CI −34.585 to −4.913, p = 0.018). Commitment posters did not reduce antibiotic prescribing. An automated patient antimicrobial stewardship message showed effects and requires further testing.

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