Trial reportAcademic emergency medicine : official journal of the Society for Academic Emergency Medicine2019
A Multifaceted Intervention Improves Prescribing for Acute Respiratory Infection for Adults and Children in Emergency Department and Urgent Care Settings.
Trial report in Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 2 of them syntheses that pooled it.
What it found
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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.
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Who cites it
46 citing papers in PubMed, 2 syntheses or guidelines pooled it, 80 citations in OpenAlex.
- Audit and feedback: effects on professional practice.The Cochrane database of systematic reviews · 2025Pooled it
- Antimicrobial stewardship programs in emergency departments: how do we measure antimicrobial use? A systematic review.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2021Pooled it
- Evaluation of pharmacist guided intervention using procalcitonin and respiratory virus testing.The American journal of emergency medicine · 2023Trial
- Let's Talk About Antibiotics: a randomised trial of two interventions to reduce antibiotic misuse.BMJ open · 2022Trial
- Review
- Cluster-Randomized Trials in Emergency Care Research.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2026Review
- Combining an antibiotic stewardship program with a 15-pathogen viral panel to reduce inappropriate antibiotic prescribing.Microbiology spectrum · 2026Article
- Mixed-method evaluation of interactive provider dashboards for comparison of outpatient antibiotic prescribing for respiratory and otic conditions in walk-in clinics.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Article
- Physician Feedback Reduces Antibiotic Prescribing for Uncomplicated Upper Respiratory Tract Infection in the Emergency Department.Antibiotics (Basel, Switzerland) · 2025Article
- Effects of the Nudge Theory-Based Multifaceted Intervention on Reducing Inappropriate Proton Pump Inhibitors Use for Prophylaxis in Hospitalized Patients: A Non-Randomized Controlled Study.Journal of general internal medicine · 2025Article
- Rapid diagnosis of acute pediatric respiratory infections with Point-of-Care and multiplex molecular testing.Infection · 2025Review
- Integrating an antimicrobial stewardship bundle into advanced urgent care sites.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- Antimicrobial Stewardship in the Pediatric Emergency Department: An Observational Pre-Post Study.Children (Basel, Switzerland) · 2024Article
- Optimal Pediatric Outpatient Antibiotic Prescribing.JAMA network open · 2024Article
- Primary Healthcare Physicians' Insufficient Knowledge Is Associated with Antibiotic Overprescribing for Acute Upper Respiratory Tract Infections in China: A Cross-Sectional Study.Antibiotics (Basel, Switzerland) · 2024Article
- Evaluation of the WHO standards to assess quality of care for children with acute respiratory infections: findings of a baseline multicentre assessment (CHOICE) in Italy.BMJ paediatrics open · 2024Observational
- Specifying behavioural and strategy components of de-implementation efforts targeting low-value prescribing practices in secondary health care.Implementation science communications · 2024Article
- Research agenda for antibiotic stewardship within the Veterans' Health Administration, 2024-2028.Infection control and hospital epidemiology · 2024Article
- Antibiotic Stewardship: A Decade of Progress.Infectious disease clinics of North America · 2023Review
- Perception of nudge interventions to mitigate medication errors risk in healthcare service delivery.BMC health services research · 2023Article
Corrections and comments
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Authors and funding
9 authors at 6 institutions in 1 country.
Funding
Abstract
backgroundAntibiotics are commonly prescribed during emergency department (ED) and urgent care center (UCC) visits for viral acute respiratory infection (ARI). We evaluate the comparative effectiveness of an antibiotic stewardship intervention adapted for acute care ambulatory settings (adapted intervention) to a stewardship intervention that additionally incorporates behavioral nudges (enhanced intervention) in reducing inappropriate prescriptions.
methodsThis study was a pragmatic, cluster-randomized clinical trial conducted in three academic health systems comprising five adult and pediatric EDs and four UCCs. Randomization of the nine sites was stratified by health system; all providers at each site received either the adapted or the enhanced intervention. The main outcome was the proportion of antibiotic-inappropriate ARI diagnosis visits that received an outpatient antibiotic prescription by individual providers. We estimated a hierarchical mixed-effects logistic regression model comparing visits during the influenza season for 2016 to 2017 (baseline) and 2017 to 2018 (intervention).
resultsThere were 44,820 ARI visits among 292 providers across all nine cluster sites. Antibiotic prescribing for ARI visits dropped from 6.2% (95% confidence interval [CI] = 4.5% to 7.9%) to 2.4% (95% CI = 1.3% to 3.4%) during the study period. We found a significant reduction in inappropriate prescribing after adjusting for health-system and provider-level effects from 2.2% (95% CI = 1.0% to 3.4%) to 1.5% (95% CI = 0.7% to 2.3%) with an odds ratio of 0.67 (95% CI = 0.54 to 0.82). Difference-in-differences between the two interventions was not significantly different.
conclusionImplementation of antibiotic stewardship for ARI is feasible and effective in the ED and UCC settings. More intensive behavioral nudging methods were not more effective in high-performance settings.
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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.