Evidence map›Paper›PMID 23915885›Full record

Trial reportLancet (London, England)2013

Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial.

Paul Little, Beth Stuart, Nick Francis, Elaine Douglas, Sarah Tonkin-Crine, Sibyl Anthierens, Jochen W L Cals, Hasse Melbye, Miriam Santer, Michael Moore and 17 more

4 registry-linked trialsAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Lancet (London, England), 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 4 registered trials, which are not on this map. Cited by 245 papers, 18 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
245citing papers in PubMed, 18 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03265028 completednot on this mapstarted 2017, after this paper: background citation

National Implementation of a Multifaceted Web-based Communication Training to Reduce of Inappropriate Antibiotic Prescribing for (Lower) Respiratory Tract Infections

Typeobservational_patient_registrySponsorUniversiteit AntwerpenRan2017 to 2018Enrolled15,802ConditionsRespiratory Tract InfectionsArmsTRACE e-learning
NCT03540706 nacompletednot on this mapstarted 2018, after this paper: background citation

Impact of the Use of C-reactive Protein in a Micro-method on the Prescription of Antibiotics in General Practitioners Consulting in the Office

TypeinterventionalSponsorCentre Hospitalier Intercommunal CreteilRan2018 to 2023Enrolled406ConditionsRespiratory Infection, Respiratory Infections in ChildrenArmsCare with C-reactive protein assay in micro method
NCT03674775 naunknown statusnot on this mapstarted 2022, after this paper: background citation

Dialogue Around Respiratory Illness Treatment for Family Practice (DART -FP)

TypeinterventionalSponsorSeattle Children's HospitalRan2022 to 2026Enrolled180ConditionsAcute Respiratory Tract InfectionArmsDART QI Program Participation
NCT05166369 nacompletednot on this mapstarted 2022, after this paper: background citation

Optimisation of Antibiotic Prescription in Acute Non-complicated Respiratory Tract Infections in Children: a Multicenter Factorial Randomised Controlled Trial Targeting Health Professionals and Parents.

TypeinterventionalSponsorFundació Institut de Recerca de l'Hospital de la Santa Creu i Sant PauRan2022 to 2023Enrolled222ConditionsAcute Respiratory Tract InfectionsArmsCommunication skills training, Mobile phone application on RTI
3 · Its place in the literature

Who cites it

245 citing papers in PubMed, 18 syntheses or guidelines pooled it.

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  17. E-learning for health professionals.The Cochrane database of systematic reviews · 2018
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185 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

27 authors.

Paul LittlePrimary Care and Population Sciences Division, University of Southampton, Southampton, UK. p.little@soton.ac.uk
Beth Stuart
Nick Francis
Elaine Douglas
Sarah Tonkin-Crine
Sibyl Anthierens
Jochen W L Cals
Hasse Melbye
Miriam Santer
Michael Moore
Samuel Coenen
Chris Butler
Kerenza Hood
Mark Kelly
Maciek Godycki-Cwirko
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
Lucy Yardley
GRACE consortium

Funding

Department of Health PDF-2009-02-45
6 · The paper itself

Abstract

backgroundHigh-volume prescribing of antibiotics in primary care is a major driver of antibiotic resistance. Education of physicians and patients can lower prescribing levels, but it frequently relies on highly trained staff. We assessed whether internet-based training methods could alter prescribing practices in multiple health-care systems.

methodsAfter a baseline audit in October to December, 2010, primary-care practices in six European countries were cluster randomised to usual care, training in the use of a C-reactive protein (CRP) test at point of care, in enhanced communication skills, or in both CRP and enhanced communication. Patients were recruited from February to May, 2011. This trial is registered, number ISRCTN99871214.

resultsThe baseline audit, done in 259 practices, provided data for 6771 patients with lower-respiratory-tract infections (3742 [55·3%]) and upper-respiratory-tract infections (1416 [20·9%]), of whom 5355 (79·1%) were prescribed antibiotics. After randomisation, 246 practices were included and 4264 patients were recruited. The antibiotic prescribing rate was lower with CRP training than without (33% vs 48%, adjusted risk ratio 0·54, 95% CI 0·42-0·69) and with enhanced-communication training than without (36% vs 45%, 0·69, 0·54-0·87). The combined intervention was associated with the greatest reduction in prescribing rate (CRP risk ratio 0·53, 95% CI 0·36-0·74, p<0·0001; enhanced communication 0·68, 0·50-0·89, p=0·003; combined 0·38, 0·25-0·55, p<0·0001).

interpretationInternet training achieved important reductions in antibiotic prescribing for respiratory-tract infections across language and cultural boundaries.

fundingEuropean Commission Framework Programme 6, National Institute for Health Research, Research Foundation Flanders.

Indexed as

InternetAcute DiseaseAnti-Bacterial AgentsClinical CompetenceCluster AnalysisCommunicationC-Reactive ProteinEuropeFemaleGeneral PracticeHumansInservice TrainingMaleMiddle AgedPoint-of-Care SystemsPractice Patterns, Physicians'Anti-Bacterial AgentsC-Reactive Protein

Identifiers

PMID23915885
PMCPMC3807804

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.