RT Journal Article
SR Electronic
T1 Antibiotic Prescribing for Acute Respiratory Tract Infections 12 Months After Communication and CRP Training: A Randomized Trial
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 125
OP 132
DO 10.1370/afm.2356
VO 17
IS 2
A1 Paul Little
A1 Beth Stuart
A1 Nick Francis
A1 Elaine Douglas
A1 Sarah Tonkin-Crine
A1 Sibyl Anthierens
A1 Jochen W.L. Cals
A1 Hasse Melbye
A1 Miriam Santer
A1 Michael Moore
A1 Samuel Coenen
A1 Chris C. Butler
A1 Kerenza Hood
A1 Mark Kelson
A1 Maciek Godycki-Cwirko
A1 Artur Mierzecki
A1 Antoni Torres
A1 Carl Llor
A1 Melanie Davies
A1 Mark Mullee
A1 Gilly O’Reilly
A1 Alike van der Velden
A1 Adam W.A. Geraghty
A1 Herman Goossens
A1 Theo Verheij
A1 Lucy Yardley
A1 ,
YR 2019
UL http://www.annfammed.org/content/17/2/125.abstract
AB 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.