Long Term Effect of General Practitioner Education on Antibiotic Prescribing

Study Overview
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Brief Summary
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Respiratory tract infections are the most common indication for antibiotic prescribing in primary care. Several studies have shown a strong relationship between antibiotic use and bacterial resistance. The aim of this trial was to assess the long-term effect of a continuous education program on general practitioners antibiotic prescribing behaviour. 170 physicians were included in this study. Physicians randomized in the education group attended a two days seminar focused on evidence-based guidelines on antibiotic use in respiratory tract infections. The intervention was limited at physicians level and did not target the patients.

Official Title
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Long Term Effect of General Practitioner Education on Antibiotic Prescribing: a Large Scale Randomized Study

Conditions
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Respiratory Tract Infections

Intervention / Treatment
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* Other: Experimental: Training to antibiotic prescription
* Other: No education on antibiotic prescription rules.


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: General practitioners practicing in three departments of the Parisian area in France General practitioners attending a two days didactic educational meeting on evidence-based guidelines for diagnosis and treatment of acute respiratory tract infection. Exclusion Criteria: None
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Training to antibiotic prescription<br>Physicians randomized in the education group attended a two days seminar focussed on evidence-based guidelines on antibiotic use in respiratory tract infections. | Other: Experimental: Training to antibiotic prescription<br>* GPs assigned to the intervention group attended a two days didactic educational meeting on evidence-based guidelines for diagnosis and treatment of acute respiratory tract infection.<br>|
| Placebo Comparator: control<br> | Other: No education on antibiotic prescription rules.<br>* GPs assigned to control group received no specific recommendations on antibiotic prescription.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in the percentage of prescriptions containing an antibiotic between control and intervention groups (seminar on the treatment of respiratory tract infections). | All prescriptions written by all general practitioners enrolled in the study were extracted each year from the French National Health System database. All data were compared to 2004 (baseline). Education group GPs attended a two-day seminar presenting evidence-based guidelines on antibiotic prescription in respiratory tract infections. The change (compared to baseline) in the percentage of prescriptions containing an antibiotic (antibiotic prescription rates) was compared between control and intervention groups. | Effect of the intervention 4 to 6 months after the educational training. | 
| Change in the cost of antibiotic prescription between control and intervention groups (seminar on the treatment of respiratory tract infections). | All prescriptions written by all general practitioners enrolled in the study were extracted each year from the French National Health System database. All data were compared to 2004 (baseline). Education group GPs attended a two-day seminar presenting evidence-based guidelines on antibiotic prescription in respiratory tract infections. The change (compared to baseline) in the cost of antibiotic prescription was compared between control and intervention groups. | Effect of the intervention 4 to 6 months after the educational training. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Long term antibiotic prescription rates | Long term change in the percentage of antibiotic prescriptions between both groups | Effect of the intervention 28 to 30 months after the educational training. | 
| Long term antibiotic cost. | Long term change in the cost of antibiotic prescriptions between both groups | Effect of the intervention 28 to 30 months after the educational training. | 
| Symptomatic drug prescription rates | Prescription rates of symptomatic drug for respiratory infections between both groups | Effect of the intervention 28 to 30 months after the educational training. | 
| Symptomatic drug cost. | Cost of symptomatic drug between both groups | Effect of the intervention 28 to 30 months after the educational training. | 
| Effect of patient age. | Effect of patient age on antibiotic prescription between both groups | Effect of the intervention 28 to 30 months after the educational training. | 
| Effect of a seminar on problem-solving strategy on prescriptions. | A second randomization was performed among the intervention group. In one subgroup, GPs attended an additional seminar on problem-solving strategies. Antibiotic prescription rates were compared between controls, evidence-based and problem-solving subgroups. Antibiotic cost was also compared between the both subgroups | Effect of the intervention 28 to 30 months after the educational training. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Antibiotic, Prescribing behaviour, Guidelines, Respiratory tract infections, Non-antibiotic prescription