An Educational Intervention to Improve the Use of Antibiotics in Portuguese Health Professional

Study Overview
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Brief Summary
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This is a cluster randomised controlled trial covering all general practitioners working in the National Health System (SNS) and all pharmacists working in community pharmacies in the area covered by the Health Region Administration of Center (ARS-C) . A specific educative intervention, designed from gaps detected in knowledge and attitudes with respect to antibiotics and resistance, will be carried out on the intervention group. The control group will not receive any specific intervention. Hypotheses: The attitudes and knowledge towards antibiotics generate habits of prescription by physicians The attitudes and knowledge towards to antibiotics generate propensity to dispense antibiotics without prescription by pharmacists The identification of the attitudes, knowledge and factors that generate habits of inadequate prescription will allow the design of specific educative interventions to improve the use of antibiotics The identification of the attitudes, knowledge and factors that generate propensity to dispense antibiotics without prescription will allow the design of specific educative interventions to antibiotic use The interventions designed from gaps detected in knowledge and attitudes with respect to antibiotics and resistance will improve the prescription and dispensation of antibiotics by physicians and pharmacists, respectively. The intervention will collaborate in the control of the bacterial resistance.

Detailed Description
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The intervention will consist of group outreach visits (40 minutes), and will be targeted at changing the knowledge-attitudes previously found to be associated with poor prescribing of antibiotics in the case of physicians and propensity to dispense antibiotics without medical prescription in the case of pharmacists.. An observational cohort study of a sample of 1100 primary care physicians and 1200 community pharmacists will be carried out to identify knowledge-attitudes associated with inappropriate prescribing of antibiotics. The independent variables (knowledge-attitudes) will be assessed by a self-administered postal questionnaire and dependent variables are some quantity and quality indicators of the prescribing antibiotics, and consumption data.

Official Title
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An Educational Intervention to Improve the Use of Antibiotics in Portuguese Health Professional: Cluster-randomized Trial

Conditions
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Antibiotics Misuse

Intervention / Treatment
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* Other: Multidisciplinary and multifaceted educational intervention.


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All general practitioners working during the period of the study in the National System of Health (SNS) All pharmacists working during the period study in the community pharmacies.
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: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Educational multifaceted intervention<br>Multidisciplinary and multifaceted educational intervention about antibiotic prescription and dispense, in physicians and pharmacists. | Other: Multidisciplinary and multifaceted educational intervention.<br>* Outreach visits (40 minutes) which included a PowerPoint presentation and impress materials: poster; flyers; participation certificate and articles mentioned in the presentation. This outreach visit aimed to change the knowledge-attitudes previously identified in a previous study as being associated with poor prescribing of antibiotics in the case of physicians and propensity to dispense antibiotics without medical prescription in the case of pharmacists.<br>|
| No Intervention: Control<br>Physicians and pharmacists that not received the multidisciplinary and multifaceted educational intervention about antibiotic prescription and dispense. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change From Baseline Antibiotic Consumption at 18 Months, in Primary Care | To quantify antibiotic drug consumption, we used monthly sales data sourced from IMS Health® and we used the quality indicators validated by Coenen S et al., (2007) to calculate monthly prescribing rates. | up to 18 months | 
| Antibiotic Monthly Sales Data and Quality Indicators Monthly Prescribing Rates. | antibiotic monthly sales data, obtained from IMS and quality indicators monthly prescribing rates, according to the ESAC indicators. | May 2012- September 2014 |