scholarly journals Optimizing antibiotic prescribing for acute cough in general practice: a cluster-randomized controlled trial

2004 ◽  
Vol 54 (3) ◽  
pp. 661-672 ◽  
Author(s):  
Samuel Coenen ◽  
Paul Van Royen ◽  
Barbara Michiels ◽  
Joke Denekens
Keyword(s):  
General Practice ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Cluster Randomized Controlled Trial ◽  
Antibiotic Prescribing ◽  
Acute Cough ◽  
Randomized Controlled ◽  
Cluster Randomized

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 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.

scholarly journals The EAST-Dem study: a pilot cluster randomized controlled trial

2017 ◽  
Vol 30 (5) ◽  
pp. 769-773 ◽  
Author(s):  
Naaheed Mukadam ◽  
Claudia Cooper ◽  
Gill Livingston
Keyword(s):  
General Practice ◽  
Randomized Controlled Trial ◽  
South Asian ◽  
Controlled Trial ◽  
Full Scale ◽  
Cluster Randomized Controlled Trial ◽  
Randomized Controlled ◽  
Memory Problems ◽  
Cluster Randomized ◽  
Asian People

ABSTRACTWe recruited eight general practice (GP) practices for a pilot cluster randomized controlled trial (RCT) of a digital versatile disc/leaflet encouraging South Asian people to seek timely help for memory problems. Primary outcomes were feasibility (proportion of patients expressing interest, consenting) and acceptability. Seventy-eight of one hundred and two (76%) potential participants consented; 76/78 (97%) were followed-up. Thirty-seven of forty-one (90%) receiving the intervention rated this acceptable. Only 17/41 (41%) accessed it; they appeared then to be more likely to seek timely help. The intervention was acceptable and feasible but a full-scale RCT would be very expensive. It may be proportionate to make this intervention available without a full-scale RCT.

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