The Implementation of Academic Detailing Interventions on the Prescribing of Antimicrobial Drugs in Primary Health Care

Study Overview
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Brief Summary
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World increase in mortality from consequences of antimicrobial resistance (AMR) represents a significant public health problem. Irrational prescribing of antimicrobial drugs (AMD) in general population is one of the main causes of development AMR. This is also contributed by fact that up to 90% of total antimicrobial consumption in Europe is related to the general population. Problem of AMR has been recognized by World Health Organization and Council of European Union, which support the establishment of the antimicrobial stewardship team (A-team). A-team provides co-ordinated interventions that promote rational use of AMD. To date, no study has been carried out in which A-team from hospital environment goes to primary health care for the purpose of rationalization prescribing of AMD by primary health care practitioners. Project for implementation of hospital A-team in primary health care in Koprivnica-Križevci County was initiated using academic detailing method aimed at rationalization of the consumption of AMD.

Official Title
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The Impact of the Implementation of Academic Detailing Interventions Based on Scientific Evidence on the Prescribing of Antimicrobial Drugs in Primary Health Care

Conditions
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Upper Respiratory Tract Infections, Acute Respiratory Tract Infection, Viral Infection

Intervention / Treatment
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* Behavioral: Academic detailing intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All primary care physicians in Koprivnica Križevci County that agree to participate in the study Exclusion Criteria: Primary care physicians outside Koprivnica Križevci County

Ages Eligible for Study
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Minimum Age: 25 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Experimental group in Koprivnica Križevci County<br>Hospital A-team provided academic detailing intervention to primary care physicians in Koprivnica Križevci county who agree to participate | Behavioral: Academic detailing intervention<br>* Academic detailing or educational outreach is a method based on scientific data with the help of educated A-team members in the form of direct (face-to-face) interactions, prescribing practices change and adherence improves according to the application of currently valid therapeutic guidelines<br>|
| No Intervention: Control group in Koprivnica Križevci county<br>Primary care physicians in Koprivnica Križevci county who did not agree to participate in academic detailing intervention | |
| No Intervention: Control group in Bjelovar Bilogora county<br>Primary care physicians in Bjelovar Bilogora county without the academic detailing intervention | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of antimicrobials expressed as DDD per day for ATC group J01 associated with acute respiratory tract infections | Rationalization of consumption of antimicrobials for acute respiratory tract infections (for associated ICD diagnoses J01, J02, J03, J06, J20) | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Clostridiodes dificile infection for patients on antimicrobial therapy | Number of Clostridiodes dificile infection for patients on antimicrobial therapy. A case of Clostridioides difficile infection (CDI) is defined as diarrhoeal stools or toxic megacolon and a positive laboratory assay for C. difficile toxin A and/or B in stools or a toxin-producing C. difficile organism detected in stool via culture or other means e.g. a positive PCR result. | 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Antimicrobial resistance, Hospital A-team, Academic detailing intervention, Antimicrobial prescribing, Primary care