Trial reportBMC health services research2013
One size does not fit all: evaluating an intervention to reduce antibiotic prescribing for acute bronchitis.
Trial report in BMC health services research, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 4 of them syntheses that pooled 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.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
33 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Improving healthcare professionals' interactions with patients to tackle antimicrobial resistance: a systematic review of interventions, barriers, and facilitators.Frontiers in public health · 2024Pooled it
- The effects of clinical decision support system for prescribing medication on patient outcomes and physician practice performance: a systematic review and meta-analysis.BMC medical informatics and decision making · 2021Pooled it
- What maximizes the effectiveness and implementation of technology-based interventions to support healthcare professional practice? A systematic literature review.BMC medical informatics and decision making · 2018Pooled it
- Ambulatory Antibiotic Stewardship through a Human Factors Engineering Approach: A Systematic Review.Journal of the American Board of Family Medicine : JABFMPooled it
- Trial
- Impact of Clinical Decision Support on Antibiotic Prescribing for Acute Respiratory Infections: a Cluster Randomized Implementation Trial.Journal of general internal medicine · 2020Trial
- Spicae aetheroleum in uncomplicated acute bronchitis: a double-blind, randomised clinical trial.Wiener medizinische Wochenschrift (1946) · 2019Trial
- Effects of primary care antimicrobial stewardship outreach on antibiotic use by general practice staff: pragmatic randomized controlled trial of the TARGET antibiotics workshop.The Journal of antimicrobial chemotherapy · 2018Trial
- Reducing antibiotic prescriptions for respiratory tract infections in family practice: results of a cluster randomized controlled trial evaluating a multifaceted peer-group-based intervention.NPJ primary care respiratory medicine · 2016Trial
- Article
- The role of electronic health records systems in de-implementing low-value care in primary care: a scoping review.Implementation science communications · 2025Review
- Implementing high-value, cost-conscious care: experiences of Irish doctors and the role of education in facilitating this approach.BMC medical education · 2024Article
- Appropriate use of antibiotics for acute respiratory infections at primary healthcare facilities in China: a nationwide cross-sectional study from 2017 to 2019.The Lancet regional health. Western Pacific · 2023Article
- Assessment of Changes in Visits and Antibiotic Prescribing During the Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use and the COVID-19 Pandemic.JAMA network open · 2022Article
- Knowledge and Practice of Antibiotic Management and Prudent Prescribing among Polish Medical Doctors.International journal of environmental research and public health · 2022Article
- Uncertainty as a critical determinant of antibiotic prescribing in patients with an asthma exacerbation: a qualitative study.The Journal of asthma : official journal of the Association for the Care of Asthma · 2022Article
- Association of antibiotics with veteran visit satisfaction and antibiotic expectations for upper respiratory tract infections.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2022Article
- Exploring antibiotic prescribing in public and private primary care settings in Singapore: a qualitative analysis informing theory and evidence-based planning for value-driven intervention design.BMC family practice · 2021Article
- Prevalence of and Factors Associated with Antibiotic Prescriptions in Patients with Acute Lower and Upper Respiratory Tract Infections-A Case-Control Study.Antibiotics (Basel, Switzerland) · 2021Article
- Impact of a Social Marketing Intervention on General Practitioners' Antibiotic Prescribing Practices for Acute Respiratory Tract Complaints in Malta.Antibiotics (Basel, Switzerland) · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
Abstract
backgroundOveruse of antibiotics for upper respiratory tract infections (URIs) and acute bronchitis is a persistent and vexing problem. In the U.S., more than half of all patients with upper respiratory tract infections and acute bronchitis are treated with antibiotics annually, despite the fact that most cases are viral in etiology and are not responsive to antibiotics. Interventions aiming to reduce unnecessary antibiotic prescribing have had mixed results, and successes have been modest. The objective of this evaluation is to use mixed methods to understand why a multi-level intervention to reduce antibiotic prescribing for acute bronchitis among primary care providers resulted in measurable improvement in only one third of participating clinicians.
methodsClinician perspectives on print-based and electronic intervention strategies, and antibiotic prescribing more generally, were elicited through structured telephone surveys at high and low performing sites after the first year of intervention at the Geisinger Health System in Pennsylvania (n = 29).
resultsCompared with a survey on antibiotic use conducted 10 years earlier, clinicians demonstrated greater awareness of antibiotic resistance and how it is impacted by individual prescribing decisions-including their own. However, persistent perceived barriers to reducing prescribing included patient expectations, time pressure, and diagnostic uncertainty, and these factors were reported as differentially undermining specific intervention components' effectiveness. An exam room poster depicting a diagnostic algorithm was the most popular strategy.
conclusionsFuture efforts to reduce antibiotic prescribing should address multi-level barriers identified by clinicians and tailor strategies to differences at individual clinician and group practice levels, focusing in particular on changing how patients and providers make decisions together about antibiotic use.
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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.