D'Hulster Leon, Abrams Steven, Bruyndonckx Robin, Anthierens Sibyl, Adriaenssens Niels, Butler Chris C, Verheij Theo, Goossens Herman, Little Paul, Coenen Samuel
National Institute for Health and Disability Insurance, Galileelaan 5/01, 1210 Brussels, Belgium.
Global Health Institute, Department of Family Medicine & Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium.
JAC Antimicrob Resist. 2022 Jun 29;4(3):dlac070. doi: 10.1093/jacamr/dlac070. eCollection 2022 Jun.
Primary care is responsible for a large proportion of unnecessary antibiotic use, which is one of the main drivers of antibiotic resistance. Randomized trials have found that online communication skills training for GPs reduces antibiotic prescribing for respiratory infections. This study assesses the real-world effect of implementing online communication skills training in general practice.
In a closed cohort stepped-wedge cluster randomized trial all Belgian GPs were invited to participate in online communication skills training courses (TRACE and INTRO) and provided with linked patient information booklets. The primary outcome was the antibiotic prescribing rate per 1000 patient contacts. Intention-to-treat and per protocol analyses were performed. Trial registration at ClinicalTrials.gov: NCT03265028.
In total, 118 487 observations from 10 375 GPs were included in the analysis. Overall, 299 (2.88%) GPs completed TRACE and 93 (0.90%) completed INTRO, 30 of which completed both. There was no effect of the national implementation of TRACE and INTRO on the population-level antibiotic prescribing rate (prescribing rate ratio [PRR] = 0.99 [95% CI: 0.97-1.02]). GPs who actually completed TRACE prescribed fewer antibiotic prescriptions (PRR = 0.93 [95% CI: 0.90-0.95]).
Inviting GPs to complete an online communication skills training course and providing them with the linked patient information booklets did not reduce antibiotic prescribing. However, GPs who completed TRACE prescribed 7% fewer antibiotics, especially during winter. This suggests a significant decrease in population-wide antibiotic consumption could be achieved by focusing on increasing the uptake of this intervention by identifying and overcoming barriers to participation.
基层医疗对很大一部分不必要的抗生素使用负有责任，而这是抗生素耐药性的主要驱动因素之一。随机试验发现，针对全科医生的在线沟通技能培训可减少呼吸道感染的抗生素处方。本研究评估了在全科医疗中实施在线沟通技能培训的实际效果。
在一项封闭队列阶梯楔形整群随机试验中，邀请了所有比利时全科医生参加在线沟通技能培训课程（TRACE和INTRO），并为他们提供相关的患者信息手册。主要结局是每1000次患者接触的抗生素处方率。进行了意向性分析和符合方案分析。在ClinicalTrials.gov上的试验注册号：NCT03265028。
分析共纳入了来自10375名全科医生的118487条观察数据。总体而言，299名（2.88%）全科医生完成了TRACE，93名（0.90%）完成了INTRO，其中30名同时完成了两者。全国实施TRACE和INTRO对人群水平的抗生素处方率没有影响（处方率比[PRR]=0.99[95%CI：0.97-1.02]）。实际完成TRACE的全科医生开出的抗生素处方较少（PRR=0.93[95%CI：0.90-0.9]）。
邀请全科医生完成在线沟通技能培训课程并为他们提供相关的患者信息手册并没有减少抗生素处方。然而，完成TRACE的全科医生开出的抗生素减少了7%，尤其是在冬季。这表明，通过识别和克服参与障碍来提高这种干预措施（在线沟通技能培训）的采用率，有可能显著降低全人群的抗生素消费量。
