Evidence map›Paper›PMID 30755451›Full record

Trial reportBMJ (Clinical research ed.)2019

Effectiveness and safety of electronically delivered prescribing feedback and decision support on antibiotic use for respiratory illness in primary care: REDUCE cluster randomised trial.

Martin C Gulliford, A Toby Prevost, Judith Charlton, Dorota Juszczyk, Jamie Soames, Lisa McDermott, Kirin Sultana, Mark Wright, Robin Fox, Alastair D Hay and 4 more

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ (Clinical research ed.), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 78 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
78citing papers in PubMed, 8 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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

78 citing papers in PubMed, 8 syntheses or guidelines pooled it.

  1. Pooled it
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  3. Tailored interventions to address determinants of practice.The Cochrane database of systematic reviews · 2026
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  18. [Antibiotic use: psychological factors influencing perceptions and behavior of physicians and patients].Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz · 2026
    Review
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18 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors.

Martin C GullifordSchool of Population Health and Environmental Sciences, King's College London, Guy's Campus, King's College London, London, UK martin.gulliford@kcl.ac.uk.ORCID http://orcid.org/0000-0003-1898-9075
A Toby PrevostSchool of Population Health and Environmental Sciences, King's College London, Guy's Campus, King's College London, London, UK.
Judith CharltonSchool of Population Health and Environmental Sciences, King's College London, Guy's Campus, King's College London, London, UK.
Dorota JuszczykSchool of Population Health and Environmental Sciences, King's College London, Guy's Campus, King's College London, London, UK.
Jamie SoamesClinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK.
Lisa McDermottSchool of Population Health and Environmental Sciences, King's College London, Guy's Campus, King's College London, London, UK.
Kirin SultanaClinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK.
Mark WrightClinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK.
Robin FoxThe Health Centre, Bicester, Oxfordshire, UK.
Alastair D HayCentre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK.
Paul LittlePrimary Care Research Group, University of Southampton, Southampton, UK.
Michael V MoorePrimary Care Research Group, University of Southampton, Southampton, UK.
Lucy YardleyDepartment of Psychology, University of Southampton, Southampton, UK.
Mark AshworthSchool of Population Health and Environmental Sciences, King's College London, Guy's Campus, King's College London, London, UK.

Funding

Department of Health HTA/13/88/10Department of Health RP-PG-0608-10018
6 · The paper itself

Abstract

objectivesTo evaluate the effectiveness and safety at population scale of electronically delivered prescribing feedback and decision support interventions at reducing antibiotic prescribing for self limiting respiratory tract infections.

designOpen label, two arm, cluster randomised controlled trial.

settingUK general practices in the Clinical Practice Research Datalink, randomised between 11 November 2015 and 9 August 2016, with final follow-up on 9 August 2017.

participants79 general practices (582 675 patient years) randomised (1:1) to antimicrobial stewardship (AMS) intervention or usual care.

interventionsAMS intervention comprised a brief training webinar, automated monthly feedback reports of antibiotic prescribing, and electronic decision support tools to inform appropriate prescribing over 12 months. Intervention components were delivered electronically, supported by a local practice champion nominated for the trial.

main outcome measuresPrimary outcome was the rate of antibiotic prescriptions for respiratory tract infections from electronic health records. Serious bacterial complications were evaluated for safety. Analysis was by Poisson regression with general practice as a random effect, adjusting for covariates. Prespecified subgroup analyses by age group were reported.

resultsThe trial included 41 AMS practices (323 155 patient years) and 38 usual care practices (259 520 patient years). Unadjusted and adjusted rate ratios for antibiotic prescribing were 0.89 (95% confidence interval 0.68 to 1.16) and 0.88 (0.78 to 0.99, P=0.04), respectively, with prescribing rates of 98.7 per 1000 patient years for AMS (31 907 prescriptions) and 107.6 per 1000 patient years for usual care (27 923 prescriptions). Antibiotic prescribing was reduced most in adults aged 15-84 years (adjusted rate ratio 0.84, 95% confidence interval 0.75 to 0.95), with one antibiotic prescription per year avoided for every 62 patients (95% confidence interval 40 to 200). There was no evidence of effect for children younger than 15 years (adjusted rate ratio 0.96, 95% confidence interval 0.82 to 1.12) or people aged 85 years and older (0.97, 0.79 to 1.18); there was also no evidence of an increase in serious bacterial complications (0.92, 0.74 to 1.13).

conclusionsElectronically delivered interventions, integrated into practice workflow, result in moderate reductions of antibiotic prescribing for respiratory tract infections in adults, which are likely to be of importance for public health. Antibiotic prescribing to very young or old patients requires further evaluation.

trial registrationISRCTN95232781.

Indexed as

AdolescentAdultAgedAged, 80 and overAnti-Bacterial AgentsAntimicrobial StewardshipDecision Support TechniquesElectronic Health RecordsFeedbackFemaleGeneral PracticeHumansMaleMiddle AgedPractice Patterns, Physicians'Primary Health CareAnti-Bacterial Agents

Identifiers

PMID30755451
PMCPMC6371944

What OpenQuestion holds

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Registered trials

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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.