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Table 4 Characteristics of trials with one post-intervention measurement

From: Reduction of antibiotic prescriptions for acute respiratory tract infections in primary care: a systematic review

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.
  1. *Abx prescription rate antibiotic prescription rate, CRP C-reactive protein, CDSS clinical decision support systems, CST communication skills training, CG control group, EHR electronic health record, IG intervention group, n.r. not reported, POCT point-of-care-testing, RADT rapid antigen detection test, RTI respiratory tract infection
  2. **Cals et al. 2009 and Cals et al. 2010: Antibiotic prescription data of the patient sample were captured during the index consultation (T1) and within 28 days after the index consultation. As T2 prescription rates include T1 prescription rates, this study is considered as a study with one post-intervention measurement