Interventions to improve adherence to first-line antibiotics in respiratory tract infections. The impact depends on the intensity of the intervention

Abstract

Background: Many interventions aimed at improving the quality of antibiotic prescribing have been investigated, but more knowledge is needed regarding the impact of different intensity interventions.

Objectives: To compare the effect of two interventions, a basic intervention (BI) and intensive intervention (II), aimed to improve the adherence to recommendations on first-line antibiotics in patients with respiratory tract infections (RTIs).

Methods: General practitioners (GPs) from different regions of Spain were offered two different interventions on antibiotic prescribing. They registered all patients with RTIs during 15 days before (2008) and after (2009) the intervention. GPs in Catalonia were exposed to BI including prescriber feedback, clinical guidelines and training sessions focused on appropriate antibiotic prescribing. The other group of GPs was exposed to an II, which besides BI, also included training and access to point-of-care tests in practice.

Results: The GPs registered 15 073 RTIs before the intervention and 12 760 RTIs after. The antibiotic prescribing rate reduced from 27.7% to 19.8%. Prescribing of first-choice antibiotics increased after the intervention in both groups. In the group of GPs following the BI, first-line antibiotics accounted for 23.8% of antibiotics before the intervention and 29.4% after (increase 5.6%, 95% confidence interval (CI): 1.2–10%), while in the group of GPs following the II these figures were 26.2% and 48.6% (increase 22.4%, 95% CI: 18.8–26%), respectively.

Conclusion: Multifaceted interventions targeting GPs can improve adherence to recommendations for first-line antibiotic prescribing in patients with RTI, with intensive interventions that include point-of-care testing being more effective.

Keywords::

• Respiratory tract infections
• antibiotics
• intervention
• guideline

ACKNOWLEDGEMENTS

The authors should like to acknowledge the particular contribution of Carolina Pérez, Juan de Dios Alcántara, Manuel Gómez, Marina Cid, Gloria Guerra, Jesús Ortega, María Luisa Cigüenza, Vicenta Pineda, José Paredes, Juan Luis Burgazzoli, Silvia Hernández and Anders Munck and all physicians who have participated in the Happy Audit study.

FUNDING

This project is a Specific Targeted Research Project (STREP) funded by The European Commission: DG SANCO under the Programme Framework 6 (SP5A–CT–2007–044154). Contract Number 044154.

Declaration of interest: CL reports having a grant from the Fundació Jordi Gol i Gurina for a research stage at the University of Cardiff. He also reports receiving research grants from the European Commission (Sixth and Seventh Programme Framework), Catalan Society of Family Medicine, and Instituto de Salud Carlos III (Spanish Ministry of Health). The other authors do not have any conflict of interest.