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Optimizing Antibiotic Prescribing for Acute Respiratory Tract Infection in German Primary Care: Study Protocol for
Christin Löffler1, Antje Krüger1, Anne Daubmann2
1Institute of General Practice, Rostock University Medical Center, Rostock, Germany.
Background:
The emergence and increased spread of microbial resistance is a major challenge to all health care systems worldwide. In primary care, acute respiratory tract infection (ARTI) is the health condition most strongly related to antibiotic overuse.
Objective:
The RESIST program aims at optimizing antibiotic prescribing for ARTI in German primary care. By completing a problem-orientated online training course, physicians are motivated and empowered to utilize patient-centered doctor-patient communication strategies, including shared decision making, in the treatment of patients with ARTI.
Methods:
RESIST will be evaluated in the form of a nonrandomized controlled trial. Approximately 3000 physicians of 8 (out of 16) German federal states can participate in the program. Patient and physician data are retrieved from routine health care data. Physicians not participating in the program serve as controls, either among the 8 participating regional Associations of Statutory Health Insurance Physicians (control group 1) or among the remaining associations not participating in RESIST (control group 2). Antibiotic prescription rates before the intervention (T0: 2016, 1st and 2nd quarters of 2017) and after the intervention (T1: 3rd quarter of 2017 until 1st quarter of 2019) will be compared. The primary outcome measure is the overall antibiotic prescription rate for all patients insured with German statutory health insurance before and after provision of the online course. The secondary outcome is the antibiotic prescription rate for coded ARTI before and after the intervention.
Results:
RESIST is publicly funded by the Innovations funds of the Federal Joint Committee in Germany and was approved in December 2016. Recruitment of physicians is now completed, and a total of 2460 physicians participated in the intervention. Data analysis started in February 2020.
Conclusions:
With approximately 3000 physicians participating in the program, RESIST is among the largest real-world interventions aiming at reducing inadequate antibiotic prescribing for ARTI in primary care. Long-term follow up of up to 21 months will allow for investigating the sustainability of the intervention.
Trial Registration:
ISRCTN Registry ISRCTN13934505; http://www.isrctn.com/ISRCTN13934505.
International Registered Report Identifier (Irrid):
RR1-10.2196/18648.
Insights
The RESIST program trained German primary care physicians to reduce antibiotic overuse for acute respiratory tract infections (ARTI). This large-scale intervention aims to improve antibiotic prescribing and combat microbial resistance.
Area of Science:
- Public Health
- Infectious Diseases
- Primary Care Medicine
Background:
- Microbial resistance is a global healthcare challenge, with antibiotic overuse in primary care for acute respiratory tract infections (ARTI) being a significant contributor.
- Optimizing antibiotic prescribing is crucial to mitigate the spread of antimicrobial resistance and improve patient outcomes.
Purpose of the Study:
- The RESIST program aims to reduce inappropriate antibiotic prescribing for ARTI in German primary care settings.
- It empowers physicians with patient-centered communication strategies, including shared decision-making, through an online training course.
Main Methods:
- A non-randomized controlled trial evaluated the RESIST program involving approximately 3000 physicians across 8 German federal states.
- Routine healthcare data from participating physicians (intervention group) and non-participating physicians (control groups) were analyzed.
- Antibiotic prescription rates were compared before (2016-2017) and after (2017-2019) the online training intervention.
Main Results:
- The RESIST program successfully recruited 2460 physicians for the intervention.
- Public funding was secured, and the intervention was approved in December 2016, with data analysis commencing in February 2020.
Conclusions:
- The RESIST program represents one of the largest real-world interventions targeting inadequate antibiotic prescribing for ARTI in primary care.
- Long-term follow-up will assess the sustainability of the intervention's impact on antibiotic prescribing habits.
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