scholarly journals An Audit and Feedback Intervention for Reducing Antibiotic Prescribing in General Dental Practice: The RAPiD Cluster Randomised Controlled Trial

PLoS Medicine ◽  
2016 ◽  
Vol 13 (8) ◽  
pp. e1002115 ◽  
Author(s):  
Paula Elouafkaoui ◽  
Linda Young ◽  
Rumana Newlands ◽  
Eilidh M. Duncan ◽  
Andrew Elders ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Audit And Feedback ◽  
Antibiotic Prescribing ◽  
Dental Practice ◽  
Feedback Intervention ◽  
Cluster Randomised ◽  
General Dental Practice ◽  
Randomised Controlled

scholarly journals A cluster randomised, controlled trial of the value of dental health educators in general dental practice

BDJ ◽  
2003 ◽  
Vol 195 (7) ◽  
pp. 395-400 ◽  
Author(s):  
A S Blinkhorn ◽  
D Gratrix ◽  
P J Holloway ◽  
Y M Wainwright-Stringer ◽  
S J Ward ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Dental Health ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Dental Practice ◽  
Health Educators ◽  
Cluster Randomised ◽  
General Dental Practice ◽  
Randomised Controlled

scholarly journals Impact of audit and feedback with action implementation toolbox on improving ICU pain management: cluster-randomised controlled trial

2019 ◽  
pp. bmjqs-2019-009588 ◽  
Author(s):  
Marie-José Roos-Blom ◽  
Wouter T Gude ◽  
Evert de Jonge ◽  
Jan Jaap Spijkstra ◽  
Sabine N van der Veer ◽  
...  
Keyword(s):  
Pain Management ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Audit And Feedback ◽  
Outcome Indicators ◽  
Pain Scores ◽  
Cluster Randomised ◽  
Randomised Controlled ◽  
Adequate Pain Management

BackgroundAudit and feedback (A&F) enjoys widespread use, but often achieves only marginal improvements in care. Providing recipients of A&F with suggested actions to overcome barriers (action implementation toolbox) may increase effectiveness.ObjectiveTo assess the impact of adding an action implementation toolbox to an electronic A&F intervention targeting quality of pain management in intensive care units (ICUs).Trial designTwo-armed cluster-randomised controlled trial. Randomisation was computer generated, with allocation concealment by a researcher, unaffiliated with the study. Investigators were not blinded to the group assignment of an ICU.ParticipantsTwenty-one Dutch ICUs and patients eligible for pain measurement.InterventionsFeedback-only versus feedback with action implementation toolbox.OutcomeProportion of patient-shift observations where pain management was adequate; composed by two process (measuring pain at least once per patient in each shift; re-measuring unacceptable pain scores within 1 hour) and two outcome indicators (acceptable pain scores; unacceptable pain scores normalised within 1 hour).Results21 ICUs (feedback-only n=11; feedback-with-toolbox n=10) with a total of 253 530 patient-shift observations were analysed. We found absolute improvement on adequate pain management in the feedback-with-toolbox group (14.8%; 95% CI 14.0% to 15.5%) and the feedback-only group (4.8%; 95% CI 4.2% to 5.5%). Improvement was limited to the two process indicators. The feedback-with-toolbox group achieved larger effects than the feedback-only group both on the composite adequate pain management (p<0.05) and on measuring pain each shift (p<0.001). No important adverse effects have occurred.ConclusionFeedback with toolbox improved the number of shifts where patients received adequate pain management compared with feedback alone, but only in process and not outcome indicators.Trial registration numberNCT02922101.

scholarly journals Impact of a multifaceted intervention to improve antibiotic prescribing: a pragmatic cluster-randomised controlled trial

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Adolfo Figueiras ◽  
◽  
Paula López-Vázquez ◽  
Cristian Gonzalez-Gonzalez ◽  
Juan Manuel Vázquez-Lago ◽  
...  
Keyword(s):  
Primary Care ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Cost Savings ◽  
Cluster Randomised Controlled Trial ◽  
Multifaceted Intervention ◽  
Educational Outreach ◽  
Antibiotic Prescribing ◽  
Cluster Randomised ◽  
Randomised Controlled

Abstract 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.

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