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Antibiotic prescribing for acute respiratory tract infections 12 months after communication and CRP training: a randomized trial

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 C., Hood, Kerenza, Kelson, 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 and Yardley, Lucy 2019. Antibiotic prescribing for acute respiratory tract infections 12 months after communication and CRP training: a randomized trial. Annals of Family Medicine 17 (2) , pp. 125-132. 10.1370/afm.2356
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Abstract

PURPOSE C-reactive-protein (CRP) is useful for diagnosis of lower respiratory tract infections (RTIs). A large international trial documented that Internet-based training in CRP point-of-care testing, in enhanced communication skills, or both reduced antibiotic prescribing at 3 months, with risk ratios (RRs) of 0.68, 0.53, 0.38, respectively. We report the longer-term impact in this trial. METHODS A total of 246 general practices in 6 countries were cluster-randomized to usual care, Internet-based training on CRP point-of-care testing, Internet-based training on enhanced communication skills and interactive booklet, or both interventions combined. The main outcome was antibiotic prescribing for RTIs after 12 months. RESULTS Of 228 practices providing 3-month data, 74% provided 12-month data, with no demonstrable attrition bias. Between 3 months and 12 months, prescribing for RTIs decreased with usual care (from 58% to 51%), but increased with CRP training (from 35% to 43%) and with both interventions combined (from 32% to 45%); at 12 months, the adjusted RRs compared with usual care were 0.75 (95% CI, 0.51-1.00) and 0.70 (95% CI, 0.49-0.93), respectively. Between 3 months and 12 months, the reduction in prescribing with communication training was maintained (41% and 40%, with an RR at 12 months of 0.70 [95% CI, 0.49-0.94]). Although materials were provided for free, clinicians seldom used booklets and rarely used CRP point-of-care testing. Communication training, but not CRP training, remained efficacious for reducing prescribing for lower RTIs (RR = 0.7195% CI, 0.45-0.99, and RR = 0.76; 95% CI, 0.47-1.06, respectively), whereas both remained efficacious for reducing prescribing for upper RTIs (RR = 0.60; 95% CI, 0.37-0.94, and RR = 0.58; 95% CI, 0.36-0.92, respectively). CONCLUSIONS Internet-based training in enhanced communication skills remains effective in the longer term for reducing antibiotic prescribing. The early improvement seen with CRP training wanes, and this training becomes ineffective for lower RTIs, the only current indication for using CRP testing

Item Type: Article
Date Type: Published Online
Status: Published
Schools: Medicine
Publisher: American Academy of Family Physicians (AAFP) / Annals of Family Medicine / HighWire
ISSN: 1544-1709
Date of First Compliant Deposit: 16 May 2019
Date of Acceptance: 31 December 2018
Last Modified: 30 Nov 2019 05:37
URI: http://orca.cf.ac.uk/id/eprint/122607

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