Ferrat E, Le Breton J, Guéry E, Adeline F, Audureau E, Montagne O, Roudot-Thoraval F, Attali C, Le Corvoisier P, Renard V
Department of General Practice, School of Medicine, Université Paris Est Créteil (UPEC), Creteil F-94000, CEpiA (Clinical Epidemiology and Aging) Unit EA 7376, A-TVB DHU, IMRB, Université Paris Est Créteil (UPEC), Créteil F-94010,
Department of General Practice, School of Medicine, Université Paris Est Créteil (UPEC), Creteil F-94000, CEpiA (Clinical Epidemiology and Aging) Unit EA 7376, A-TVB DHU, IMRB, Université Paris Est Créteil (UPEC), Créteil F-94010.
Fam Pract. 2016 Apr;33(2):192-9. doi: 10.1093/fampra/cmv107. Epub 2016 Jan 21.
The few studies assessing long-term effects of educational interventions on antibiotic prescription have produced conflicting results.
Our aim was to assess the effects after 4.5 years of an interactive educational seminar designed for GPs and focused on antibiotic therapy in respiratory tract infections (RTIs). The seminar was expected to decrease antibiotic prescriptions for any diagnosis.
We conducted a randomized controlled parallel-group trial in a Paris suburb (France), with GPs as the randomization unit and prescriptions as the analysis unit. The intervention occurred in September 2004 and the final assessment in March 2009. Among 203 randomized GPs, 168 completed the study, 70 in the intervention group and 98 in the control group. Intervention GPs were randomized to attending only a 2-day interactive educational seminar on evidence-based guidelines about managing RTIs or also 1 day of problem-solving training. The primary outcome was the percentage of change in the proportion of prescriptions containing an antibiotic for any diagnosis in 2009 versus 2004. An intention-to-treat sensitivity analysis was performed using multiple imputation.
After 4.5 years, absolute changes in the primary outcome measure were -1.1% (95% confidence interval: -2.2 to 0.0) in the intervention group and +1.4% (0.3-2.6) in the control group, yielding an adjusted between-group difference of -2.2% (-2.7 to -1.7; P < 0.001). Both intervention modalities had significant effects, and multiple imputation produced similar results.
A single, standardized and interactive educational seminar targeting GPs significantly decreased antibiotic use for RTIs after 4.5 years.
少数评估教育干预对抗生素处方长期影响的研究得出了相互矛盾的结果。
我们的目的是评估为全科医生设计的、聚焦于呼吸道感染（RTIs）抗生素治疗的互动式教育研讨会在4.5年后的效果。该研讨会预期会减少任何诊断情况下的抗生素处方。
我们在法国巴黎的一个郊区进行了一项随机对照平行组试验，以全科医生作为随机分组单位，处方作为分析单位。干预于2004年9月进行，最终评估于2009年3月进行。在203名随机分组的全科医生中，168名完成了研究，干预组70名，对照组98名。干预组的全科医生被随机分配，要么仅参加为期2天的关于RTIs管理循证指南的互动式教育研讨会，要么还参加为期1天的问题解决培训。主要结局是2009年与2004年相比，任何诊断情况下含抗生素处方比例的变化百分比。使用多重填补法进行意向性分析。
4.5年后，主要结局指标的绝对变化在干预组为-1.1%（95%置信区间：-2.2至0.0），在对照组为+1.4%（0.3 - 2.6），调整后的组间差异为-2.2%（-2.7至-1.7；P < 0.001）。两种干预方式均有显著效果，多重填补法得出了类似结果。
针对全科医生的单一、标准化且互动式的教育研讨会在4.5年后显著减少了RTIs的抗生素使用。
