Smeets H M, Kuyvenhoven M M, Akkerman A E, Welschen I, Schouten G P, van Essen G A, Verheij T J M
Julius Center for Health Sciences and Primary Care, University Medical Center, PO Box 85500, Utrecht 3500 GA, The Netherlands.
Fam Pract. 2009 Jun;26(3):183-7. doi: 10.1093/fampra/cmp008. Epub 2009 Mar 3.
A multiple intervention targeted to reduce antibiotic prescribing with an educational outreach programme had proven to be effective in a randomized controlled trial in 12 peer review groups, demonstrating 12% less prescriptions for respiratory tract infections.
To assess the effectiveness of a multiple intervention in primary care at a large scale.
A controlled before and after study in 2006 and 2007 was designed. Participants were from general practices within a geographically defined area in the middle region of The Netherlands. Participants were GPs in 141 practices in 25 peer review groups. A control group of GP practices from the same region, matched for type of practice and mean volume of antibiotic prescribing. The multiple intervention consisted of the following elements: (i) group education meeting and communication training; (ii) monitoring and feedback on prescribing behaviour; (iii) group education for GPs and pharmacists assistants and (iv) patient education material. The main outcome measures are as follows: (i) number of antibiotic prescriptions per 1000 patients per GP and (ii) number of second-choice antibiotics, obtained from claims data from the regional health insurance company. The associations between predictors and outcome measurements were assessed by means of a multiple regression analyses.
At baseline, the number of antibiotic prescriptions per 1000 patients was slightly higher in the intervention group than in the control group (184 versus 176). In 2007, the number of prescriptions had increased to 232 and 227, respectively, and not differed between intervention and control group.
The implementation of an already proven effective multiple intervention strategy at a larger scale showed no reduction of antibiotic prescription rates. The failure might be attributed to a less tight monitoring of intervention and audit. Inserting practical tools in the intervention might be more successful and should be studied.
在一项针对12个同行评审小组的随机对照试验中，一项旨在通过教育推广计划减少抗生素处方的多重干预措施已被证明是有效的，呼吸道感染的处方减少了12%。
大规模评估初级保健中多重干预措施的有效性。
设计了一项2006年和2007年的前后对照研究。参与者来自荷兰中部一个地理区域内的全科诊所。参与者是25个同行评审小组中141家诊所的全科医生。对照组是来自同一地区的全科诊所，在诊所类型和抗生素处方平均数量方面进行了匹配。多重干预措施包括以下几个方面：（i）小组教育会议和沟通培训；（ii）对处方行为的监测和反馈；（iii）针对全科医生和药剂师助理的小组教育；（iv）患者教育材料。主要结局指标如下：（i）每位全科医生每1000名患者的抗生素处方数量；（ii）从地区健康保险公司的索赔数据中获得的二线抗生素数量。通过多元回归分析评估预测因素与结局指标之间的关联。
在基线时，干预组每1000名患者的抗生素处方数量略高于对照组（184对176）。2007年，两组的处方数量分别增加到232和227，干预组和对照组之间没有差异。
在更大规模上实施一项已被证明有效的多重干预策略并未降低抗生素处方率。失败可能归因于对干预和审计的监测不够严格。在干预措施中加入实用工具可能会更成功，值得研究。
