Table 3 Characteristics of studies with baseline data and post-intervention measurements

Bjerrum et al. 2006

Spain

Two-armed cluster-randomised controlled intervention study

> 14 years

Consultation due to upper/lower RTI

T0: 1114/not performed; n.r.

T1: 1674/2462; n.r.

Physicians on T0: 52

Physicians on T1: 17/35

IG: training for physicians + feedback and reflection of baseline—Abx prescription rate + introduction to POCT (CRP and RADT)

CG: care as usual

Abx prescription rate right after initial consultation:

T0: only for IG (Dec.–Feb. 02/03)

T1: 1 year after I (Dec.–Feb. 04/05)

n.r.

Altiner et al. 2007

Germany

Two-armed cluster-randomised controlled intervention study

> 16 years

First episode of acute cough (no cough for the previous 8 weeks)

T0: 753/898; 42.2/42

T1: 675/885; 44.9/43.9

T2: 787/920; 41.7/41.8

Physicians on T0: 104

Physicians on T1: 42/44

Physicians on T2: 28/33

IG: communication training for physicians + handouts for patients and waiting room poster

CG: care as usual

Abx prescription rate right after initial consultation:

T0: Nov.–Jan. 03/04

T1: 6 weeks after I (Feb.–Apr. 2004)

T2: 1 year after I (Jan.–Mar. 2005)

n.r.

Gonzales et al. 2013

USA

Three-armed cluster-randomised controlled intervention study

13–64 years

Consultation due to uncomplicated acute bronchitis (ICD-9-CM code 466.0; ICD-9-CM code 490)

(No RTI consultation in the last 30 days)

T0:

Arm 1: 3639; n.r.

Arm 2: 2974; n.r.

Arm 3: 3195; n.r.

T1:

Arm 1: 1001; n.r.

Arm 2: 1017; n.r.

Arm 3: 950; n.r.

11 “practice centres” for each study arm

Arm 1: 68 physicians

Arm 2: 41 physicians

Arm 3: 46 physicians

IG 1:

1) Training for physicians (via “clinical champion”)

2) Patient brochure

3) Examination room poster with clinical algorithm for acute bronchitis

IG 2:

1) and 2)

instead of 3) ➔ clinical algorithm integrated in practice software

CG: care as usual

Abx prescription rate right after initial consultation:

T0: baseline (3 successive winter periods from Oct. to Mar. 2007–2009)

T1: Oct. 2009–Mar. 2010

Hospitalisations and emergency room visits occurred rarely in all study arms (no published data)

Gjelstad et al. 2013**

Norway

Two-armed cluster-randomised controlled intervention study

> 13 years

Consultation due to acute RTI

Number of RTI consultations on T0 for patients > 13 years: 43880/46518

Number of RTI-consultations on T1 for patients > 13 years: 47522/47868

Number of physicians on T0:

39 education groups (202 physicians); n.r./41 education groups (232 physicians); n.r.

Number of physicians on T1:

39 education groups (183 physicians); 48.3/40 education groups (199 physicians); 49.7

IG 1:

1) Meeting: guidelines for RTI and strategy of delayed prescribing; installation of additional program for 2 of 4 practice software (reminders to document the number of days for delayed prescribing)

2) Meeting: feedback on prescribing rates based on individual data

3) 1-day seminar: reinforcement of intervention

IG 2:

Training regarding adequate pharmacotherapy on patients > 70 years in 2 group meetings and 1-day peer visit, based on individual prescribing rates; antibiotic therapy was not content

2 data collection periods for Abx prescription rate:

T0: (Abx prescription rate during 1 year before I by retrospective data analysis with special software)

I: Dec. 2005–May 2006

T1: Abx prescription rate during 1 year (after I)

n.r.

Little et al. 2013

Belgium, Spain, Wales, Great Britain, Poland, Netherlands

Multinational cluster-randomised controlled intervention study, factorial study design

> 18 years

First episode of acute cough (max. of 28 days)

First episode of upper/lower RTI

T0: 6771; 49.6

T1: 4264

Arm 1 = CG: 870

Arm 2 = IG 1: 1062

Arm 3 = IG 2: 1170

Arm 4 = IG 3: 1162

Factorial groups:

POCT-CRP-group (arms 2 + 4): 2224; 51.0

CG for CRP-POCT = no CRP-POCT group (arms 1 + 3): 2040; 50.9

CST-group (arms 3 + 4): 2332; 51.1

CG for CST = no CST group (arms 1 + 2): 1932; 50.8

Physicians on T0: 259 practices

Physicians on T1: 228 practices; 372 physicians

CG:

care as usual

IG 1:

Internet-based training for CRP-POCT

IG 2:

Internet-based communication training

IG 3:

Internet-based training for communication training + CRP-POCT

Abx prescription rate right after initial consultation:

T0: Oct.–Dec. 2010

T1: Feb.–May 2011

Deaths: none

Hospitalisations:

CG: 2

IG 1: 10

IG 2: 6

IG 3: 12

Difference in hospitalisation rate between cumulative CRP group and cumulative non-CRP group: 22/8 (OR* = 2.91, 95% CI 0.96–8.85, p = 0.06)

Cluster-adjusted: OR* = 2·61, 95% CI 1.07–6.35, p = 0.034

Andreeva et al. 2014

Russia

Two-armed cluster-randomised controlled intervention study

Patients ≥ 18 years with first episode of acute cough/lower RTI (including acute bronchitis, pneumonia and infectious exacerbations of COPD or asthma)

T0 for subgroup of 13 GPs: 47/34; n.r.

T1 for subgroup of 13 GPs: 81/62; n.r.

T1: 101/78; 50.8/50.8

Physicians: a total of 18 GPs participated, but only 13 GPs participated in baseline and intervention period

IG:

1) Registration of patient’s symptoms, clinical examination and therapy in electronic case report form

2) 2 training sessions concerning the CRP test, guidelines about the interpretation of CRP results, discussion about paper cases of patients with different RTIs and different CRP values

CG: 1)

Abx prescription rate during I period (12 weeks—from 30 January to 30 April 2010)

T0: only for 13 GPs 2 months before data collection

T1: Abx prescription rate right after initial consultation

T2: Abx prescription rate 2 weeks after initial consultation

n.r.

Gulliford et al. 2014

UK

Two-armed cluster-randomised controlled intervention study

Patients aged 18–59 years consulting for RTI

T0: 292,398/264,137; n.r.

T1: 294,929/263,895; n.r.

50 family practices were allocated to IG, and 50 practices were allocated to CG

IG: decision support tool including a summary of antibiotic prescribing recommendations and research evidence concerning no antibiotic or delayed antibiotic prescribing strategies + a single-sided patient information sheet, information on the definite indications for antibiotic prescription

CG: care as usual

Abx prescription rate during two 12-month data collection periods:

T0: 12-month period before I

T1: 12-month period after I

n.r.

Meeker et al. 2016

USA

Cluster-randomised controlled intervention study, 2 × 2 × 2 factorial design

Patients ≥ 18 years with no visit for acute RTI within the prior 30 days

No. of patients: 14,753/16,959

No. of patients T0/T1 for each study group:

IG 1: 2132/2388

IG 2: 1491/1979

IG 3: 1236/1620

IG 1 + 2: 1977/2131

IG 1 + 3: 1511/2014

IG 2 + 3: 2362/2240

IG 1 + 2 + 3: 2178/2492

CG: 1866/2095

No. of practices/physicians for T0 and T1: 47/248

No. of practices/physicians/mean age of patients for each study group:

IG 1: 6/42/48

IG 2: 7/35/53

IG 3: 4/20/47

IG 1 + 2: 6/34/50

IG 1 + 3: 6/35/48

IG 2 + 3: 6/27/49

IG 1 + 2 + 3: 6/28/43

CG: 6/27/49

7 IGs:

I1: “Suggested alternatives”—EHR-based intervention (resembling CDSS) triggered by a RTI. User gets a list of alternative treatment (e.g. over-the-counter medicine)

I2: “Accountable justification”—EHR-based I triggered by antibiotic prescriptions. User must explicitly justify the treatment decision.

I3: “Peer comparison”—monthly e-mail with individual number and proportion of adequate and inadequate antibiotic prescriptions for acute RTI compared with other physicians

I4: I1 + I2

I5: I1 + I3

I6: I2 + I3

I7: I1 + I2 + I3

CG: care as usual

Abx prescription rate for inadequate antibiotic prescriptions for acute RTI

T0: 18-month baseline for each practice

T1: 18-month period (beginning Nov. 2011 to Oct. 2012, ending for the last practice in Apr. 2014)

Return visit rate within 30 days after initial consultation in which no antibiotics were prescribed:

Among CG practices: 0.43% (95% CI 0.25–0.70)

Among I2 and I3 practices: 1.41% (95% CI 1.06–1.85, p < 0.001)

Among return visits, a random sample of 33 cases across all study groups was monitored for complications/hospitalizations:

11 cases of pneumonia, 1 otitis media, 1 pneumonia + otitis media

1 hospitalisation for pneumonia