Table 4 Characteristics of trials with one post-intervention measurement
Study, country and study design | Inclusion criteria for patients | Number of patients (I/C)*; average age of patients (I/C)*; number of physicians (I/C*) | Intervention and control group* | Data collection periods | Number of adverse events (e.g. hospitalisations, deaths) or side effects |
|---|---|---|---|---|---|
Briel et al. 2006 Switzerland Three-armed cluster-randomised controlled intervention study | > 18 years First episode of acute RTI (symptoms for max. of 28 days) | T1: “Unlimited” IG: 293; 43.6 “Full” IG: 259; 41.4 CG: 285; 40.5 15 Physicians in each study group in total: 45 physicians in 45 practices | “Limited” IG: guidelines on RTI “full” IG: additional 6-h seminar on patient-centred communication + 2-h telephone feedback CG: (care as usual) | Abx prescription rate during 2 weeks after initial consultation, registered by study pharmacies T1: January–May 2004 | Number of deaths and hospitalisations: “Limited” IG: 1 death “Full” IG: 3 hospitalisations CG: none |
Cals et al. 2009** Netherlands Cluster-randomised controlled intervention study, factorial design | > 18 years Acute cough due to lower RTI (max. of 4 weeks) | T1 and T2: Arm 1: 110 Arm 2: 84 Arm 3: 117 Arm 4: 120 Factorial groups: POCT-group (arm 1 + arm 3): 227; 49.4 CG for POCT = no POCT group (arm 2 + arm 4): 204; 50.3 CST group (arms 2 + 3): 201; 51.4 CG for CST = no CST group (arms 1 + 4): 230; 48.5; 10 physicians (5 practices) in each study arm on T1 and T2 | IG 1: POCT (CRP) IG 2: CST IG 3: POCT+CST CG: care as usual | Data collection in two winter periods 2005/2006 and 2006/2007: T1: after initial consultation T2: 28 days after initial consultation | No hospitalisations and deaths during the study |
Linder et al. 2009 USA Two-armed cluster-randomised controlled intervention study | Consultation due to upper/lower acute RTI | Number of consultations due to RTI: T1: 11954/10007; 48/49 Physicians on T1: 262/181 (in 27 “practice centres”) | IG: “ARI Smart Form” = CDSS Collection of patient data, documentation of diagnosis and therapy, presentation of therapy options with integrated CDSS Print-out option for patient handouts and specialised literature CG: care as usual | Abx prescription rate right after initial consultation: T0: baseline T1: Abx prescription rate during intervention from November 2005 to May 2006 | n.r. |
Cals et al. 2010** Netherlands Two-armed randomised controlled intervention study | > 18 years First episode of lower RTI or rhinosinusitis (max. for 4 weeks) | T1 and T2: 129/129; 43.0/45.5 33 physicians (in 11 practices) on T1 and T2 | IG: POCT for CRP measurement, CRP-dependent prescribing strategies: immediate or delayed prescribing or no prescribing CG: care as usual | Two data collection periods from November 2007 to April 2008: T1: after initial consultation T2: 28 days after initial consultation | No hospitalisations and deaths during the study |
Linder et al. 2010 USA Two-armed cluster-randomised controlled intervention study | Consultation due to upper/lower acute RTI | Number of consultations due to RTI: T1: 8406/10082; 49/49 Physicians on T1: 258/315 in 27 “practice centres” | IG: “ARI Quality Dashboard” = CDSS Collection of patient data, documentation of diagnosis and therapy, presentation of therapy options with integrated CDSS Comparison of indiv. Abx prescription rate with national RTI-prescribing data Management of billing data CG: care as usual | Abx prescription rate right after initial consultation: T0: baseline T1: Abx prescription rate during intervention from November 2006 to August 2007 | n.r. |
Worrall et l. 2010 Canada Two-armed randomised controlled intervention study | > 18 years patients with acute upper RTI | T1: 75/74; n.r. Physicians on T1: 6 | Arm 1: delayed prescribing with “normal” prescription Arm 2: delayed prescribing with post-dated prescription (48 h after initial consultation) | Abx prescription rate during 19 days after initial consultation: T1: n.r. | n.r. |
Llor et al. 2011 Spain Two-armed randomised controlled intervention study | 14–60 years patients with acute pharyngitis (≥ 1 censor criterion) | T1: 281/262; 31.8/31.5 Physicians on T1: 33/28 10 “primary care centres” in IG and CG | IG: RADT* (Strep A-Test) CG: care as usual | Abx prescription rate right after initial consultation: T1: January–May 2008 | Side effects of AB therapy (gastrointestinal side effects, rash): I: 32 C: 8 |
McGinn et al. 2013 USA Two-armed cluster-randomised controlled intervention study | Patients > 18 years were included, if electronic health record detected keywords (=diagnoses, symptoms associated with pharyngitis or pneumonia) | T1: 586/398; 43/49 In total: 168 assistant physicians, specialists and specialised nurses in 2 primary care practices | IG: 1) 1-h training on Walsh score for streptococcal pharyngitis and Heckerling score for pneumonia 2) Video presentation of CDSS* and integration in practice software 3) Entry of keywords in practice software (on pharyngitis and pneumonia); pop-up function of CDSS* with following risk score calculation and corresponding recommendations CG: (Journal article about Walsh score for streptococcal pharyngitis and Heckerling score for pneumonia) | T1: Abx prescription rate right after initial consultation (additionally prescribed Abx 2 weeks after initial consultation) in November 1, 2010–October 31, 2011 | Difference in emergency room visits between IG and CG: p > 0.99 Difference in follow-up treatment rate between IG and CG: p = 0.10 |
Hui Min Lee et al. 2016 SingaporeTwo-arm parallel group randomised controlled trial | Patients ≥ 21 years presenting with at least one of four symptoms (runny nose, blocked nose, cough or sore throat) for 7 days or less | T1: 457/457; 36/35 35 participating GPs from 24 clinics | IG: patients were educated on causes of upper respiratory tract infections CG: patients were educated on influenza vaccinations | Abx prescription rate after the initial consultation: T1: 8 working days in February 2015 | n. r. |