Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
Biostatistics Research Group, Department of Health Sciences, College of Life Sciences, University of Leicester, Leiceister, UK.
BMJ Open. 2019 Jan 21;9(1):e026925. doi: 10.1136/bmjopen-2018-026925.
Delayed prescribing can be a useful strategy to reduce antibiotic prescribing, but it is not clear for whom delayed prescribing might be effective. This protocol outlines an individual patient data (IPD) meta-analysis of randomised controlled trials (RCTs) and observational cohort studies to explore the overall effect of delayed prescribing and identify key patient characteristics that are associated with efficacy of delayed prescribing.
A systematic search of the databases Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid Embase, EBSCO CINAHL Plus and Web of Science was conducted to identify relevant studies from inception to October 2017. Outcomes of interest include duration of illness, severity of illness, complication, reconsultation and patient satisfaction. Study authors of eligible papers will be contacted and invited to contribute raw IPD data. IPD data will be checked against published data, harmonised and aggregated to create one large IPD database. Multilevel regression will be performed to explore interaction effects between treatment allocation and patient characteristics. The economic evaluation will be conducted based on IPD from the combined trial and observational studies to estimate the differences in costs and effectiveness for delayed prescribing compared with normal practice. A decision model will be developed to assess potential savings and cost-effectiveness in terms of reduced antibiotic usage of delayed prescribing and quality-adjusted life years.
Ethical approval was obtained from the University of Southampton Faculty of Medicine Research Ethics Committee (Reference number: 30068). Findings of this study will be published in peer-reviewed academic journals as well as General Practice trade journals and will be presented at national and international conferences. The results will have important public health implications, shaping the way in which antibiotics are prescribed in the future and to whom delayed prescriptions are issued.
CRD42018079400.
延迟处方是减少抗生素处方的一种有效策略，但不清楚延迟处方对谁有效。本方案概述了一项针对随机对照试验（RCT）和观察性队列研究的个体患者数据（IPD）荟萃分析，以探讨延迟处方的总体效果，并确定与延迟处方疗效相关的关键患者特征。
从建库到 2017 年 10 月，我们对 Cochrane 对照试验中心注册库、Ovid MEDLINE、Ovid Embase、EBSCO CINAHL Plus 和 Web of Science 数据库进行了系统检索，以确定相关研究。感兴趣的结局包括疾病持续时间、疾病严重程度、并发症、再次就诊和患者满意度。将联系符合条件的论文的作者，并邀请他们提供原始 IPD 数据。将对 IPD 数据与已发表数据进行核对、协调和汇总，以创建一个大型 IPD 数据库。将进行多水平回归分析，以探索治疗分配与患者特征之间的交互作用。将根据合并试验和观察性研究的 IPD 进行经济评估，以估计与常规实践相比，延迟处方的成本和效果差异。将开发决策模型，以评估延迟处方减少抗生素使用和提高质量调整生命年方面的潜在节省和成本效益。
南安普敦大学医学院研究伦理委员会（编号：30068）已获得伦理批准。本研究的结果将在同行评议的学术期刊以及普通实践贸易期刊上发表，并将在国家和国际会议上展示。研究结果将具有重要的公共卫生意义，影响未来抗生素处方的方式以及向谁开具延迟处方。
CRD42018079400。
