Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial.
Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial.
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基于互联网的培训对急性呼吸道感染的抗生素处方率的影响：跨国，群集，随机，阶乘，对照试验。
DOI：
10.1016/s0140-6736(13)60994-0
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发表时间：
2013-10-05
期刊：
影响因子：
168.9
通讯作者：
Yardley, Lucy
中科院分区：
文献类型：
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作者：
Little, Paul;Stuart, Beth;Francis, Nick;Douglas, Elaine;Tonkin-Crine, Sarah;Anthierens, Sibyl;Cals, Jochen W. L.;Melbye, Hasse;Santer, Miriam;Moore, Michael;Coenen, Samuel;Butler, Chris;Hood, Kerenza;Kelly, Mark;Godycki-Cwirko, Maciek;Mierzecki, Artur;Torres, Antoni;Llor, Carl;Davies, Melanie;Mullee, Mark;O'Reilly, Gilly;van der Velden, Alike;Geraghty, Adam W. A.;Goossens, Herman;Verheij, Theo;Yardley, Lucy
在初级保健中大量开抗生素处方是抗生素耐药性的主要驱动因素。医生和患者的教育可以降低处方水平，但它往往依赖于训练有素的工作人员。我们评估了基于互联网的培训方法是否可以改变多个医疗保健系统的处方实践。在2010年10月至12月进行基线审计后，将6个欧洲国家的初级保健实践随机分组为常规护理、在护理点使用C反应蛋白（CRP）检测的培训、增强沟通技能或CRP和增强沟通。2011年2月至5月招募患者。本试验已注册，编号ISRCTN 99871214。在259个实践中进行的基线审计提供了6771例下呼吸道感染（3742例[55.3%]）和上呼吸道感染（1416例[20.9%]）患者的数据，其中5355例（79.1%）使用抗生素。随机分组后，纳入了246例实践，招募了4264例患者。接受CRP培训的患者抗生素处方率低于未接受培训的患者（33% vs 48%，校正风险比0.54，95%CI 0.42 - 0.69），接受加强沟通培训的患者抗生素处方率低于未接受培训的患者（36% vs 45%，0.69，0.54 - 0.87）。联合干预与处方率的最大降低相关（CRP风险比0.53，95%CI 0.36 - 0.74，p<0.0001;加强沟通0.68，0.50 - 0.89，p= 0.003;联合干预0.38，0.25 - 0.55，p<0.0001）。互联网培训跨越了语言和文化的界限，大大减少了抗生素治疗泌尿道感染的处方。欧洲联盟委员会框架方案6，国家卫生研究所，研究基金会弗兰德斯。
High-volume prescribing of antibiotics in primary care is a major driver of antibiotic resistance. Education of physicians and patients can lower prescribing levels, but it frequently relies on highly trained staff. We assessed whether internet-based training methods could alter prescribing practices in multiple health-care systems. After a baseline audit in October to December, 2010, primary-care practices in six European countries were cluster randomised to usual care, training in the use of a C-reactive protein (CRP) test at point of care, in enhanced communication skills, or in both CRP and enhanced communication. Patients were recruited from February to May, 2011. This trial is registered, number ISRCTN99871214. The baseline audit, done in 259 practices, provided data for 6771 patients with lower-respiratory-tract infections (3742 [55·3%]) and upper-respiratory-tract infections (1416 [20·9%]), of whom 5355 (79·1%) were prescribed antibiotics. After randomisation, 246 practices were included and 4264 patients were recruited. The antibiotic prescribing rate was lower with CRP training than without (33% vs 48%, adjusted risk ratio 0·54, 95% CI 0·42–0·69) and with enhanced-communication training than without (36% vs 45%, 0·69, 0·54–0·87). The combined intervention was associated with the greatest reduction in prescribing rate (CRP risk ratio 0·53, 95% CI 0·36–0·74, p<0·0001; enhanced communication 0·68, 0·50–0·89, p=0·003; combined 0·38, 0·25–0·55, p<0·0001). Internet training achieved important reductions in antibiotic prescribing for respiratory-tract infections across language and cultural boundaries. European Commission Framework Programme 6, National Institute for Health Research, Research Foundation Flanders.