Effectiveness of a multiple intervention to reduce antibiotic prescribing for respiratory tract symptoms in primary care: randomised controlled trial
Effectiveness of a multiple intervention to reduce antibiotic prescribing for respiratory tract symptoms in primary care: randomised controlled trial
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DOI：
10.1136/bmj.38182.591238.eb
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发表时间：
2004-08-21
影响因子：
--
通讯作者：
Verheij, TJM
中科院分区：
文献类型：
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作者：
Welschen, I;Kuyvenhoven, MM;Verheij, TJM
目的评价旨在降低呼吸道症状抗生素处方发生率的综合干预措施的有效性。设计随机对照试验。研究对象荷兰乌得勒支地区包括100名全科医生及其合作药剂师在内的12个同行评议小组。干预措施包括小组教育会议、关于抗生素适应症和类型的共识程序和沟通技能培训；对处方行为的监测和反馈；对全科医生和药剂师助理的小组教育；对患者的教育材料。主要指标呼吸道急性症状的抗生素处方率和患者满意度。结果全科医生完成调查(%)。在基线时，针对呼吸道症状的抗生素处方率在干预组和对照组之间没有差异(分别为27%和29%)。9个月后，干预组的处方率下降到23%，而对照组的处方率上升到37%(变化的平均差异-12%，95%的可信区间-18.9%到-4.0%)。多水平分析证实了未校正分析的结果(干预效果-10.7%，-20.3%~-1.0%)。两组患者满意度均较高，干预前后差异无统计学意义。结论多重干预降低了呼吸道症状抗生素的处方使用率，同时保持了患者较高的满意度。进一步的研究应侧重于这种干预的可持续性和成本效益。
Objectives To assess the effectiveness of a multiple intervention aimed at reducing antibiotic prescription rates for symptoms of the respiratory tract in primary care.Design Randomised controlled trial.Subjects Twelve peer review groups including 100 general practitioners with their collaborating pharmacists in the region of Utrecht, Netherlands.Intervention The intervention consisted of group education meetings, with a consensus procedure on indication for and type of antibiotics and with training in communication skills; monitoring and feedback on prescribing behaviour; group education for assistants of general practitioners and pharmacists; and educational material for patients. The control group did not receive any of these elements.Main outcome measures Antibiotic prescription rates for acute symptoms of the respiratory tract and patients' satisfaction.Results 89 general practitioners completed the study (89%). At baseline, prescription rates for antibiotics for respiratory tract symptoms did not differ between intervention and control group (27% v 29%, respectively). After nine months, the prescription rates in the intervention group fell to 23%, whereas the control group's rose to 37% (mean difference in change - 12%, 95% confidence interval - 18.9% to - 4.0%). Multilevel analysis confirmed the results of the unadjusted analysis (intervention effect - 10.7%, - 20.3% to - 1.0%). Patients' satisfaction was high and did not differ in the two groups at baseline or after the intervention.Conclusions A multiple intervention reduced prescribing rates of antibiotics for respiratory tract symptoms while maintaining a high degree of satisfaction among patients. Further research should focus on the sustainability and cost effectiveness of this intervention.