Department of General Practice/Family Medicine, Institute of Health and Society, University of Oslo, P O Box 1130, Blindern, N-0318 Oslo, Norway.
BMJ. 2013 Jul 26;347:f4403. doi: 10.1136/bmj.f4403.
To assess the effects of a multifaceted educational intervention in Norwegian general practice aiming to reduce antibiotic prescription rates for acute respiratory tract infections and to reduce the use of broad spectrum antibiotics.
Cluster randomised controlled study.
Existing continuing medical education groups were recruited and randomised to intervention or control.
79 groups, comprising 382 general practitioners, completed the interventions and data extractions.
The intervention groups had two visits by peer academic detailers, the first presenting the national clinical guidelines for antibiotic use and recent research evidence on acute respiratory tract infections, the second based on feedback reports on each general practitioner's antibiotic prescribing profile from the preceding year. Regional one day seminars were arranged as a supplement. The control arm received a different intervention targeting prescribing practice for older patients.
Prescription rates and proportion of non-penicillin V antibiotics prescribed at the group level before and after the intervention, compared with corresponding data from the controls.
In an adjusted, multilevel model, the effect of the intervention on the 39 intervention groups (183 general practitioners) was a reduction (odds ratio 0.72, 95% confidence interval 0.61 to 0.84) in prescribing of antibiotics for acute respiratory tract infections compared with the controls (40 continuing medical education groups with 199 general practitioners). A corresponding reduction was seen in the odds (0.64, 0.49 to 0.82) for prescribing a non-penicillin V antibiotic when an antibiotic was issued. Prescriptions per 1000 listed patients increased from 80.3 to 84.6 in the intervention arm and from 80.9 to 89.0 in the control arm, but this reflects a greater incidence of infections (particularly pneumonia) that needed treating in the intervention arm.
The intervention led to improved antibiotic prescribing for respiratory tract infections in a representative sample of Norwegian general practitioners, and the courses were feasible to the general practitioners.
Clinical trials NCT00272155.
评估挪威普通实践中一项多方面教育干预的效果，该干预旨在降低急性呼吸道感染的抗生素处方率，并减少广谱抗生素的使用。
集群随机对照研究。
招募并随机分配现有继续医学教育组至干预组或对照组。
79 个组，包含 382 名普通医生，完成了干预和数据提取。
干预组接受了两位同行学术详细信息员的访问，第一次介绍了国家抗生素使用临床指南和急性呼吸道感染的最新研究证据，第二次则基于前一年每位普通医生抗生素处方情况的反馈报告。安排了区域一日研讨会作为补充。对照组接受了针对老年患者处方实践的不同干预。
干预前后组水平的抗生素处方率和非青霉素 V 类抗生素的处方比例，与对照组的相应数据进行比较。
在调整后的多层次模型中，与对照组（40 个继续医学教育组，199 名普通医生）相比，干预对 39 个干预组（183 名普通医生）的影响是急性呼吸道感染抗生素处方的减少（比值比 0.72，95%置信区间 0.61 至 0.84）。当开具抗生素时，非青霉素 V 类抗生素的处方比值也相应减少（0.64，0.49 至 0.82）。干预组每 1000 名患者的处方数从 80.3 增加到 84.6，对照组从 80.9 增加到 89.0，但这反映了干预组中需要治疗的感染（特别是肺炎）发生率更高。
该干预在挪威普通医生的代表性样本中导致了呼吸道感染抗生素处方的改善，并且这些课程对普通医生来说是可行的。
临床试验 NCT00272155。
