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 Little, Paul
A1 Stuart, Beth
A1 Francis, Nick
A1 Douglas, Elaine
A1 Tonkin-Crine, Sarah
A1 Anthierens, Sibyl
A1 Cals, Jochen W.L.
A1 Melbye, Hasse
A1 Santer, Miriam
A1 Moore, Michael
A1 Coenen, Samuel
A1 Butler, Chris C.
A1 Hood, Kerenza
A1 Kelson, Mark
A1 Godycki-Cwirko, Maciek
A1 Mierzecki, Artur
A1 Torres, Antoni
A1 Llor, Carl
A1 Davies, Melanie
A1 Mullee, Mark
A1 O’Reilly, Gilly
A1 van der Velden, Alike
A1 Geraghty, Adam W.A.
A1 Goossens, Herman
A1 Verheij, Theo
A1 Yardley, Lucy
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.