JAC Advance Access originally published online on July 10, 2007
Journal of Antimicrobial Chemotherapy 2007 60(3):638-644; doi:10.1093/jac/dkm254
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Reducing antibiotic prescriptions for acute cough by motivating GPs to change their attitudes to communication and empowering patients: a cluster-randomized intervention study
1 Department of General Practice, Heinrich-Heine-University Duesseldorf, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany 2 Institute of Statistics and Econometrics, University Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany
Received 19 January 2007; returned 12 February 2007; revised 14 June 2007; accepted 15 June 2007
* Corresponding author. Tel: +49-211-811-7771; Fax: +49-211-811-8755; E-mail: altiner{at}med.uni-duesseldorf.de
Objectives: Assessing the efficacy of an educational intervention that aimed to reduce unnecessary antibiotic prescriptions in primary care by motivating GPs to change their attitudes to communication and by empowering patients.
Methods: One hundred and four GPs in North-Rhine/Westphalia-Lippe, Germany were cluster-randomized into intervention and control. GPs randomized to receive the intervention were visited by peers. The intervention strategy was focused on the communication within the encounter, not on sharing knowledge about antibiotic prescribing. Leaflets and posters were provided that aimed at patient empowerment, thus enabling patients to raise the topic of antibiotic prescriptions themselves.
Results: Eighty-six GPs (83%) remained in the study at 6 weeks and 61 GPs (59%) at 12 months. Antibiotic prescription rates within the control group were 54.7% at baseline and 36.4% within the intervention group at baseline. Generalized estimating equation models were applied. Baseline imbalances and confounding variables were controlled by adjustment. After the intervention, the ORs for the prescription of an antibiotic dropped to 0.58 [95% CI: (0.43;0.78), P < 0.001] after 6 weeks and were 0.72 [95% CI: (0.54;0.97), P = 0.028] after 12 months in the intervention group. In the control group, the ORs rose to 1.52 [95% CI: (1.19;1.95), P = 0.001] after 6 weeks and were 1.31 [95% CI: (1.01;1.71), P = 0.044] after 12 months; these ORs correspond to an 
60% relative reduction in antibiotic prescription rates at 6 weeks and a persistent 40% relative reduction at 12 months.
Conclusions: An interventional strategy that focused on doctor–patient communication and patient empowerment is an effective concept to reduce antibiotic prescriptions in primary care.
Keywords: antibacterial agents , respiratory tract infections , guidelines , patient participation
Present address. Department of General Practice and Family Medicine, University of Witten/Herdecke, Alfred Herrhausen-Str. 50, 58448 Witten, Germany.