Impact of a multifaceted intervention to improve antibiotic prescribing: a pragmatic cluster-randomised controlled trial
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Outros Autores: | , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10773/31077 |
Resumo: | 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. © 2020, The Author(s). |
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Impact of a multifaceted intervention to improve antibiotic prescribing: a pragmatic cluster-randomised controlled trialAntibioticsAttitudesEducational interventionInappropriate prescribingMicrobial resistancesPhysiciansPrimary careObjectives: 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. © 2020, The Author(s).BMC2021-03-31T12:23:24Z2020-01-01T00:00:00Z2020info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10773/31077eng2047-299410.1186/s13756-020-00857-9Figueiras, AdolfoLópez-Vázquez, PaulaGonzalez-Gonzalez, CristianVázquez-Lago, Juan ManuelPiñeiro-Lamas, MaríaLópez-Durán, AnaSánchez, CoroHerdeiro, Maria TeresaZapata-Cachafeiro, Maruxainfo:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2024-05-06T04:31:14Zoai:ria.ua.pt:10773/31077Portal AgregadorONGhttps://www.rcaap.pt/oai/openairemluisa.alvim@gmail.comopendoar:71602024-05-06T04:31:14Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Impact of a multifaceted intervention to improve antibiotic prescribing: a pragmatic cluster-randomised controlled trial |
title |
Impact of a multifaceted intervention to improve antibiotic prescribing: a pragmatic cluster-randomised controlled trial |
spellingShingle |
Impact of a multifaceted intervention to improve antibiotic prescribing: a pragmatic cluster-randomised controlled trial Figueiras, Adolfo Antibiotics Attitudes Educational intervention Inappropriate prescribing Microbial resistances Physicians Primary care |
title_short |
Impact of a multifaceted intervention to improve antibiotic prescribing: a pragmatic cluster-randomised controlled trial |
title_full |
Impact of a multifaceted intervention to improve antibiotic prescribing: a pragmatic cluster-randomised controlled trial |
title_fullStr |
Impact of a multifaceted intervention to improve antibiotic prescribing: a pragmatic cluster-randomised controlled trial |
title_full_unstemmed |
Impact of a multifaceted intervention to improve antibiotic prescribing: a pragmatic cluster-randomised controlled trial |
title_sort |
Impact of a multifaceted intervention to improve antibiotic prescribing: a pragmatic cluster-randomised controlled trial |
author |
Figueiras, Adolfo |
author_facet |
Figueiras, Adolfo López-Vázquez, Paula Gonzalez-Gonzalez, Cristian Vázquez-Lago, Juan Manuel Piñeiro-Lamas, María López-Durán, Ana Sánchez, Coro Herdeiro, Maria Teresa Zapata-Cachafeiro, Maruxa |
author_role |
author |
author2 |
López-Vázquez, Paula Gonzalez-Gonzalez, Cristian Vázquez-Lago, Juan Manuel Piñeiro-Lamas, María López-Durán, Ana Sánchez, Coro Herdeiro, Maria Teresa Zapata-Cachafeiro, Maruxa |
author2_role |
author author author author author author author author |
dc.contributor.author.fl_str_mv |
Figueiras, Adolfo López-Vázquez, Paula Gonzalez-Gonzalez, Cristian Vázquez-Lago, Juan Manuel Piñeiro-Lamas, María López-Durán, Ana Sánchez, Coro Herdeiro, Maria Teresa Zapata-Cachafeiro, Maruxa |
dc.subject.por.fl_str_mv |
Antibiotics Attitudes Educational intervention Inappropriate prescribing Microbial resistances Physicians Primary care |
topic |
Antibiotics Attitudes Educational intervention Inappropriate prescribing Microbial resistances Physicians Primary care |
description |
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. © 2020, The Author(s). |
publishDate |
2020 |
dc.date.none.fl_str_mv |
2020-01-01T00:00:00Z 2020 2021-03-31T12:23:24Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10773/31077 |
url |
http://hdl.handle.net/10773/31077 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
2047-2994 10.1186/s13756-020-00857-9 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
BMC |
publisher.none.fl_str_mv |
BMC |
dc.source.none.fl_str_mv |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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mluisa.alvim@gmail.com |
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1817543775529992192 |