Please use this identifier to cite or link to this item: http://hdl.handle.net/1893/29337
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dc.contributor.authorLittle, Paulen_UK
dc.contributor.authorStuart, Bethen_UK
dc.contributor.authorFrancis, Nicken_UK
dc.contributor.authorDouglas, Elaineen_UK
dc.contributor.authorTonkin-Crine, Sarahen_UK
dc.contributor.authorAnthierens, Sibylen_UK
dc.contributor.authorCals, Jochen W Len_UK
dc.contributor.authorMelbye, Hasseen_UK
dc.contributor.authorSanter, Miriamen_UK
dc.contributor.authorMoore, Michaelen_UK
dc.contributor.authorCoenen, Samuelen_UK
dc.contributor.authorButler, Chris Cen_UK
dc.contributor.authorHood, Kerenzaen_UK
dc.contributor.authorKelson, Marken_UK
dc.contributor.authorGodycki-Cwirko, Macieken_UK
dc.date.accessioned2019-04-17T00:02:46Z-
dc.date.available2019-04-17T00:02:46Z-
dc.date.issued2019-03en_UK
dc.identifier.urihttp://hdl.handle.net/1893/29337-
dc.description.abstractPURPOSE C-reactive-protein (CRP) is useful for diagnosis of lower respiratory tract infections (RTIs). A large international trial documented that Internet-based training in CRP point-of-care testing, in enhanced communication skills, or both reduced antibiotic prescribing at 3 months, with risk ratios (RRs) of 0.68, 0.53, 0.38, respectively. We report the longer-term impact in this trial. METHODS A total of 246 general practices in 6 countries were cluster-randomized to usual care, Internet-based training on CRP point-of-care testing, Internet-based training on enhanced communication skills and interactive booklet, or both interventions combined. The main outcome was antibiotic prescribing for RTIs after 12 months. RESULTS Of 228 practices providing 3-month data, 74% provided 12-month data, with no demonstrable attrition bias. Between 3 months and 12 months, prescribing for RTIs decreased with usual care (from 58% to 51%), but increased with CRP training (from 35% to 43%) and with both interventions combined (from 32% to 45%); at 12 months, the adjusted RRs compared with usual care were 0.75 (95% CI, 0.51-1.00) and 0.70 (95% CI, 0.49-0.93), respectively. Between 3 months and 12 months, the reduction in prescribing with communication training was maintained (41% and 40%, with an RR at 12 months of 0.70 [95% CI, 0.49-0.94]). Although materials were provided for free, clinicians seldom used booklets and rarely used CRP point-of-care testing. Communication training, but not CRP training, remained efficacious for reducing prescribing for lower RTIs (RR = 0.7195% CI, 0.45-0.99, and RR = 0.76; 95% CI, 0.47-1.06, respectively), whereas both remained efficacious for reducing prescribing for upper RTIs (RR = 0.60; 95% CI, 0.37-0.94, and RR = 0.58; 95% CI, 0.36-0.92, respectively). CONCLUSIONS Internet-based training in enhanced communication skills remains effective in the longer term for reducing antibiotic prescribing. The early improvement seen with CRP training wanes, and this training becomes ineffective for lower RTIs, the only current indication for using CRP testing.en_UK
dc.language.isoenen_UK
dc.publisherAnnals of Family Medicineen_UK
dc.relationLittle P, Stuart B, Francis N, Douglas E, Tonkin-Crine S, Anthierens S, Cals JWL, Melbye H, Santer M, Moore M, Coenen S, Butler CC, Hood K, Kelson M & Godycki-Cwirko M (2019) Antibiotic Prescribing for Acute Respiratory Tract Infections 12 Months After Communication and CRP Training: A Randomized Trial. Annals of Family Medicine, 17 (2), pp. 125-132. https://doi.org/10.1370/afm.2356en_UK
dc.rightsThe publisher does not allow this work to be made publicly available in this Repository. Please use the Request a Copy feature at the foot of the Repository record to request a copy directly from the author. You can only request a copy if you wish to use this work for your own research or private study.en_UK
dc.subjectantibioticsen_UK
dc.subjectprescribingen_UK
dc.subjectantimicrobial stewardshipen_UK
dc.subjectrespiratory tract infectionsen_UK
dc.subjectantimicrobial resistanceen_UK
dc.subjectprimary careen_UK
dc.subjectclinical practice patternsen_UK
dc.subjectcommunicationen_UK
dc.subjectC-reactive proteinen_UK
dc.subjectpractice-based researchen_UK
dc.titleAntibiotic Prescribing for Acute Respiratory Tract Infections 12 Months After Communication and CRP Training: A Randomized Trialen_UK
dc.typeJournal Articleen_UK
dc.rights.embargodate2999-12-31en_UK
dc.rights.embargoreason[GRACEINTROAnnalsrevised2accepted.pdf] The publisher does not allow this work to be made publicly available in this Repository therefore there is an embargo on the full text of the work.en_UK
dc.identifier.doi10.1370/afm.2356en_UK
dc.identifier.pmid30858255en_UK
dc.citation.jtitleAnnals of Family Medicineen_UK
dc.citation.issn1544-1717en_UK
dc.citation.issn1544-1709en_UK
dc.citation.volume17en_UK
dc.citation.issue2en_UK
dc.citation.spage125en_UK
dc.citation.epage132en_UK
dc.citation.publicationstatusPublisheden_UK
dc.citation.peerreviewedRefereeden_UK
dc.type.statusAM - Accepted Manuscripten_UK
dc.contributor.funderEuropean Commissionen_UK
dc.author.emailelaine.douglas@stir.ac.uken_UK
dc.citation.date01/03/2019en_UK
dc.description.notesAdditional co-authors: Artur Mierzecki, Antoni Torres, Carl Llor, Melanie Davies, Mark Mullee, Gilly O’Reilly, Alike van der Velden, Adam W A Geraghty, Herman Goossens, Theo Verheij, and Lucy Yardley on behalf of the GRACE consortiumen_UK
dc.contributor.affiliationUniversity of Southamptonen_UK
dc.contributor.affiliationUniversity of Southamptonen_UK
dc.contributor.affiliationCardiff Universityen_UK
dc.contributor.affiliationEconomicsen_UK
dc.contributor.affiliationUniversity of Oxforden_UK
dc.contributor.affiliationUniversity of Antwerpen_UK
dc.contributor.affiliationUniversity of Maastrichten_UK
dc.contributor.affiliationThe Arctic University of Norwayen_UK
dc.contributor.affiliationUniversity of Southamptonen_UK
dc.contributor.affiliationUniversity of Southamptonen_UK
dc.contributor.affiliationUniversity of Antwerpen_UK
dc.contributor.affiliationUniversity of Oxforden_UK
dc.contributor.affiliationCardiff Universityen_UK
dc.contributor.affiliationUniversity of Exeteren_UK
dc.contributor.affiliationUniversity of Lodzen_UK
dc.identifier.isiWOS:000460916800005en_UK
dc.identifier.scopusid2-s2.0-85062826334en_UK
dc.identifier.wtid1265185en_UK
dc.contributor.orcid0000-0001-8540-1126en_UK
dc.date.accepted2018-12-31en_UK
dc.date.filedepositdate2019-04-16en_UK
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