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Changing GPs' antibiotic prescribing: a randomised controlled trial
Eileen J Wilson1, Dilruba Nasrin, Keith B G Dear
1National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory. eileen.wilson@dva.gov.au
Communicable Diseases Intelligence Quarterly Report
|June 17, 2003
Summary
Intensive guideline development significantly reduced antibiotic prescribing by general practitioners (GPs). Active GP involvement in creating evidence-based clinical guidelines led to a substantial decrease in antibiotic prescriptions.
Area of Science:
- General Practice
- Health Services Research
- Evidence-Based Medicine
Background:
- Antibiotic overuse is a significant public health concern, contributing to antimicrobial resistance.
- Clinical guidelines aim to optimize antibiotic prescribing practices in primary care.
- General practitioners (GPs) play a crucial role in antibiotic stewardship.
Purpose of the Study:
- To evaluate the effectiveness of an intensive intervention for developing and implementing clinical guidelines on antibiotic prescribing for acute respiratory infections among GPs.
- To compare the impact of an intensive guideline development intervention with a moderate intervention.
Main Methods:
- A randomized controlled trial involving 54 GPs in Canberra, Australia, from 1997-1999.
- The intensive group (24 GPs) actively participated in evidence review and guideline creation for acute respiratory infections.
- The moderate group (control GPs) received a brief educational event and guideline distribution in the second year. Prescribing data (antibiotic prescriptions per 100 Medicare services) were analyzed using a mixed-effects longitudinal time series model.
Main Results:
- The intensive intervention group showed a significant decrease in average yearly antibiotic prescribing (p=0.026).
- A mixed-effects model revealed a significant reduction in antibiotic prescribing over time in the intensive group compared to the moderate group (p<0.001).
- The intensive intervention led to a significant fall in overall antibiotic prescribing.
Conclusions:
- Actively engaging general practitioners in the development and consideration of the evidence base for clinical guidelines is an effective strategy to reduce antibiotic prescribing.
- Intensive, participatory guideline development can lead to significant improvements in antibiotic stewardship in primary care settings.
- This approach offers a promising model for promoting evidence-based practice and combating antimicrobial resistance.