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Effectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: practice based randomised controlled trial

C. C. Butler, S. A. Simpson, F. Dunstan, S. Rollnick, D. Cohen, D. Gillespie, M. R. Evans, s. l. i. e. a. p. health, M. F. Alam, M.-J. Bekkers, J. Evans, L. Moore, R. Howe, J. Hayes, M. Hare, K. Hood, Fasihul Alam

BMJ, Volume: 344, Issue: feb02 1, Pages: d8173 - d8173

Swansea University Author: Fasihul Alam

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DOI (Published version): 10.1136/bmj.d8173

Abstract

OBJECTIVE: To evaluate the effectiveness and costs of a multifaceted flexible educational programme aimed at reducing antibiotic dispensing at the practice level in primary care.DESIGN: Randomised controlled trial with general practices as the unit of randomisation and analysis. Clinicians and resea...

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Published in: BMJ
Published: 2012
URI: https://cronfa.swan.ac.uk/Record/cronfa20831
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Clinicians and researchers were blinded to group allocation until after randomisation.SETTING: 68 general practices with about 480,000 patients in Wales, United Kingdom.PARTICIPANTS: 34 practices were randomised to receive the educational programme and 34 practices to be controls. 139 clinicians from the intervention practices and 124 from control practices had agreed to participate before randomisation. Practice level data covering all the clinicians in the 68 practices were analysed.INTERVENTIONS: Intervention practices followed the Stemming the Tide of Antibiotic Resistance (STAR) educational programme, which included a practice based seminar reflecting on the practices' own dispensing and resistance data, online educational elements, and practising consulting skills in routine care. Control practices provided usual care.MAIN OUTCOME MEASURES: Total numbers of oral antibiotic items dispensed for all causes per 1000 practice patients in the year after the intervention, adjusted for the previous year's dispensing. Secondary outcomes included reconsultations, admissions to hospital for selected causes, and costs.RESULTS: The rate of oral antibiotic dispensing (items per 1000 registered patients) decreased by 14.1 in the intervention group but increased by 12.1 in the control group, a net difference of 26.1. After adjustment for baseline dispensing rate, this amounted to a 4.2% (95% confidence interval 0.6% to 7.7%) reduction in total oral antibiotic dispensing for the year in the intervention group relative to the control group (P=0.02). Reductions were found for all classes of antibiotics other than penicillinase-resistant penicillins but were largest and significant individually for phenoxymethylpenicillins (penicillin V) (7.3%, 0.4% to 13.7%) and macrolides (7.7%, 1.1% to 13.8%). There were no significant differences between intervention and control practices in the number of admissions to hospital or in reconsultations for a respiratory tract infection within seven days of an index consultation. The mean cost of the programme was &#xA3;2923 (&#x20AC;3491, $4572) per practice (SD &#xA3;1187). There was a 5.5% reduction in the cost of dispensed antibiotics in the intervention group compared with the control group (-0.4% to 11.4%), equivalent to a reduction of about &#xA3;830 a year for an average intervention practice.CONCLUSION: The STAR educational programme led to reductions in all cause oral antibiotic dispensing over the subsequent year with no significant change in admissions to hospital, reconsultations, or costs. 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F.</firstname><surname>Alam</surname><order>9</order></author><author><firstname>M.-J.</firstname><surname>Bekkers</surname><order>10</order></author><author><firstname>J.</firstname><surname>Evans</surname><order>11</order></author><author><firstname>L.</firstname><surname>Moore</surname><order>12</order></author><author><firstname>R.</firstname><surname>Howe</surname><order>13</order></author><author><firstname>J.</firstname><surname>Hayes</surname><order>14</order></author><author><firstname>M.</firstname><surname>Hare</surname><order>15</order></author><author><firstname>K.</firstname><surname>Hood</surname><order>16</order></author><author><firstname>Fasihul</firstname><surname>Alam</surname><orcid/><order>17</order></author></authors><documents/><OutputDurs/></rfc1807>
spelling 2015-04-21T17:30:43.8612733 v2 20831 2015-04-21 Effectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: practice based randomised controlled trial 642c9290a11352cb60741fc2b1004f6d Fasihul Alam Fasihul Alam true false 2015-04-21 OBJECTIVE: To evaluate the effectiveness and costs of a multifaceted flexible educational programme aimed at reducing antibiotic dispensing at the practice level in primary care.DESIGN: Randomised controlled trial with general practices as the unit of randomisation and analysis. Clinicians and researchers were blinded to group allocation until after randomisation.SETTING: 68 general practices with about 480,000 patients in Wales, United Kingdom.PARTICIPANTS: 34 practices were randomised to receive the educational programme and 34 practices to be controls. 139 clinicians from the intervention practices and 124 from control practices had agreed to participate before randomisation. Practice level data covering all the clinicians in the 68 practices were analysed.INTERVENTIONS: Intervention practices followed the Stemming the Tide of Antibiotic Resistance (STAR) educational programme, which included a practice based seminar reflecting on the practices' own dispensing and resistance data, online educational elements, and practising consulting skills in routine care. Control practices provided usual care.MAIN OUTCOME MEASURES: Total numbers of oral antibiotic items dispensed for all causes per 1000 practice patients in the year after the intervention, adjusted for the previous year's dispensing. Secondary outcomes included reconsultations, admissions to hospital for selected causes, and costs.RESULTS: The rate of oral antibiotic dispensing (items per 1000 registered patients) decreased by 14.1 in the intervention group but increased by 12.1 in the control group, a net difference of 26.1. After adjustment for baseline dispensing rate, this amounted to a 4.2% (95% confidence interval 0.6% to 7.7%) reduction in total oral antibiotic dispensing for the year in the intervention group relative to the control group (P=0.02). Reductions were found for all classes of antibiotics other than penicillinase-resistant penicillins but were largest and significant individually for phenoxymethylpenicillins (penicillin V) (7.3%, 0.4% to 13.7%) and macrolides (7.7%, 1.1% to 13.8%). There were no significant differences between intervention and control practices in the number of admissions to hospital or in reconsultations for a respiratory tract infection within seven days of an index consultation. The mean cost of the programme was £2923 (€3491, $4572) per practice (SD £1187). There was a 5.5% reduction in the cost of dispensed antibiotics in the intervention group compared with the control group (-0.4% to 11.4%), equivalent to a reduction of about £830 a year for an average intervention practice.CONCLUSION: The STAR educational programme led to reductions in all cause oral antibiotic dispensing over the subsequent year with no significant change in admissions to hospital, reconsultations, or costs. Trial registration ISRCT No 63355948. Journal Article BMJ 344 feb02 1 d8173 d8173 28 2 2012 2012-02-28 10.1136/bmj.d8173 COLLEGE NANME COLLEGE CODE Swansea University 2015-04-21T17:30:43.8612733 2015-04-21T17:28:10.2520121 Faculty of Medicine, Health and Life Sciences School of Health and Social Care C. C. Butler 1 S. A. Simpson 2 F. Dunstan 3 S. Rollnick 4 D. Cohen 5 D. Gillespie 6 M. R. Evans 7 s. l. i. e. a. p. health 8 M. F. Alam 9 M.-J. Bekkers 10 J. Evans 11 L. Moore 12 R. Howe 13 J. Hayes 14 M. Hare 15 K. Hood 16 Fasihul Alam 17
title Effectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: practice based randomised controlled trial
spellingShingle Effectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: practice based randomised controlled trial
Fasihul Alam
title_short Effectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: practice based randomised controlled trial
title_full Effectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: practice based randomised controlled trial
title_fullStr Effectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: practice based randomised controlled trial
title_full_unstemmed Effectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: practice based randomised controlled trial
title_sort Effectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: practice based randomised controlled trial
author_id_str_mv 642c9290a11352cb60741fc2b1004f6d
author_id_fullname_str_mv 642c9290a11352cb60741fc2b1004f6d_***_Fasihul Alam
author Fasihul Alam
author2 C. C. Butler
S. A. Simpson
F. Dunstan
S. Rollnick
D. Cohen
D. Gillespie
M. R. Evans
s. l. i. e. a. p. health
M. F. Alam
M.-J. Bekkers
J. Evans
L. Moore
R. Howe
J. Hayes
M. Hare
K. Hood
Fasihul Alam
format Journal article
container_title BMJ
container_volume 344
container_issue feb02 1
container_start_page d8173
publishDate 2012
institution Swansea University
doi_str_mv 10.1136/bmj.d8173
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care
document_store_str 0
active_str 0
description OBJECTIVE: To evaluate the effectiveness and costs of a multifaceted flexible educational programme aimed at reducing antibiotic dispensing at the practice level in primary care.DESIGN: Randomised controlled trial with general practices as the unit of randomisation and analysis. Clinicians and researchers were blinded to group allocation until after randomisation.SETTING: 68 general practices with about 480,000 patients in Wales, United Kingdom.PARTICIPANTS: 34 practices were randomised to receive the educational programme and 34 practices to be controls. 139 clinicians from the intervention practices and 124 from control practices had agreed to participate before randomisation. Practice level data covering all the clinicians in the 68 practices were analysed.INTERVENTIONS: Intervention practices followed the Stemming the Tide of Antibiotic Resistance (STAR) educational programme, which included a practice based seminar reflecting on the practices' own dispensing and resistance data, online educational elements, and practising consulting skills in routine care. Control practices provided usual care.MAIN OUTCOME MEASURES: Total numbers of oral antibiotic items dispensed for all causes per 1000 practice patients in the year after the intervention, adjusted for the previous year's dispensing. Secondary outcomes included reconsultations, admissions to hospital for selected causes, and costs.RESULTS: The rate of oral antibiotic dispensing (items per 1000 registered patients) decreased by 14.1 in the intervention group but increased by 12.1 in the control group, a net difference of 26.1. After adjustment for baseline dispensing rate, this amounted to a 4.2% (95% confidence interval 0.6% to 7.7%) reduction in total oral antibiotic dispensing for the year in the intervention group relative to the control group (P=0.02). Reductions were found for all classes of antibiotics other than penicillinase-resistant penicillins but were largest and significant individually for phenoxymethylpenicillins (penicillin V) (7.3%, 0.4% to 13.7%) and macrolides (7.7%, 1.1% to 13.8%). There were no significant differences between intervention and control practices in the number of admissions to hospital or in reconsultations for a respiratory tract infection within seven days of an index consultation. The mean cost of the programme was £2923 (€3491, $4572) per practice (SD £1187). There was a 5.5% reduction in the cost of dispensed antibiotics in the intervention group compared with the control group (-0.4% to 11.4%), equivalent to a reduction of about £830 a year for an average intervention practice.CONCLUSION: The STAR educational programme led to reductions in all cause oral antibiotic dispensing over the subsequent year with no significant change in admissions to hospital, reconsultations, or costs. Trial registration ISRCT No 63355948.
published_date 2012-02-28T12:42:05Z
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