JAC Advance Access originally published online on July 28, 2004
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Journal of Antimicrobial Chemotherapy 2004 54(3):661-672; doi:10.1093/jac/dkh374
JAC vol.54 no.3 © The British Society for Antimicrobial Chemotherapy 2004; all rights reserved.
Optimizing antibiotic prescribing for acute cough in general practice: a cluster-randomized controlled trial
Centre for General Practice, University of Antwerp, BE 2610 Antwerp, Belgium
* Corresponding author. Tel: +32-3-8202525; Fax: +32-3-8202526; Email: samuel.coenen{at}ua.ac.be
Objectives: To assess the effect of a tailored professional intervention, including academic detailing, on antibiotic prescribing for acute cough.
Methods: In a cluster-randomized controlled before and after study 85 Flemish GPs included adult patients with acute cough consulting in the periods February–April 2000 and 2001. The intervention consisted of a clinical practice guideline for acute cough, an educational outreach visit and a postal reminder to support its implementation in January 2001. Antibiotic prescribing rates and patients' symptom resolution were the main outcome measures.
Results: Thirty-six of 42 GPs received the intervention and 35 of 43 GPs served as controls; 1503 patients were eligible for analysis. Only in the intervention group were patients less likely to receive antibiotics after the intervention [ORadj (95% CI)=0.56 (0.36–0.87)]. Prescribed antibiotics were also more in line with the guideline in the intervention group [1.90 (0.96–3.75)] and less expensive from the perspective of the National Sickness and Invalidity Insurance Institute {MDadj (95% CI)=–
6.89 [–11.77–(–2.02)]}. No significant differences were found between the groups for the time to symptom resolution.
Conclusions: An (inter)actively delivered tailored intervention implementing a guideline for acute cough is successful in optimizing antibiotic prescribing without affecting patients' symptom resolution. Further research efforts should be devoted to cost-effectiveness studies of such interventions.
Keywords: primary care , respiratory tract infections , guidelines , antibacterials , academic detailing
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