Trial reportAntimicrobial resistance and infection control2020
Impact of a multifaceted intervention to improve antibiotic prescribing: a pragmatic cluster-randomised controlled trial.
Trial report in Antimicrobial resistance and infection control, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 3 of them syntheses that pooled it.
What it found
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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
15 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Implementation, adoption and impact of clinical decision support system for antibiotic prescribing in primary care: a systematic review.The Journal of antimicrobial chemotherapy · 2026Pooled it
- Educational Technologies to Support Rational Antimicrobial Prescribing in Primary Healthcare: A Systematic Review.International journal of environmental research and public health · 2025Pooled it
- Understanding Primary Care Physician Vaccination Behaviour: A Systematic Review.International journal of environmental research and public health · 2022Pooled it
- Article
- Trends of antibiotic use for acute upper respiratory infections in Chinese emergency departments and the impact of COVID-19: a cross-sectional study.Antimicrobial resistance and infection control · 2025Article
- Barriers and facilitators for the implementation of delayed-prescription of antibiotics in family medicine: a qualitative study.BMC health services research · 2025Article
- Identifying AWaRe indicators for appropriate antibiotic use: a narrative review.The Journal of antimicrobial chemotherapy · 2024Review
- Effects of a Primary Care Antimicrobial Stewardship Program on Meticillin-ResistantAntibiotics (Basel, Switzerland) · 2024Article
- 21st century (clinical) decision support in nursing and allied healthcare. Developing a learning health system: a reasoned design of a theoretical framework.BMC medical informatics and decision making · 2023Review
- Magnitude and determinants of inappropriate prescribing of antibiotics in dentistry: a nation-wide study.Antimicrobial resistance and infection control · 2023Article
- Knowledge, Attitudes and Practice Regarding Antibiotic Prescription by Medical Interns: A Qualitative Study in Spain.Antibiotics (Basel, Switzerland) · 2023Article
- Primary care physician responses to requests by older adults for unnecessary drugs: a qualitative study.BMC primary care · 2022Article
- Educational Interventions to Reduce Prescription and Dispensing of Antibiotics in Primary Care: A Systematic Review of Economic Impact.Antibiotics (Basel, Switzerland) · 2022Review
- Antimicrobial Stewardship at Transitions of Care to Outpatient Settings: Synopsis and Strategies.Antibiotics (Basel, Switzerland) · 2022Review
- Article
Corrections and comments
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThis study sought to assess the effectiveness and return on investment (ROI) of a multifaceted intervention aimed at improving antibiotic prescribing for acute respiratory infections in primary care.
designLarge-sized, two-arm, open-label, pragmatic, cluster-randomised controlled trial.
settingAll primary care physicians working for the Spanish National Health Service (NHS) in Galicia (region in north-west Spain).
participantsThe seven spatial clusters were distributed by unequal randomisation (3:4) of the intervention and control groups. A total of 1217 physicians (1.30 million patients) were recruited from intervention clusters and 1393 physicians (1.46 million patients) from control clusters.
interventionsOne-hour educational outreach visits tailored to training needs identified in a previous study; an online course integrated in practice accreditation; and a clinical decision support system.
main outcome measuresChanges in the ESAC (European Surveillance of Antimicrobial Consumption) quality indicators for outpatient antibiotic use. We used generalised linear mixed and conducted a ROI analysis to ascertain the overall cost savings.
resultsMedian follow-up was 19 months. The adjusted effect on overall antibiotic prescribing attributable to the intervention was - 4.2% (95% CI: - 5.3% to - 3.2%), with this being more pronounced for penicillins - 6.5 (95% CI: - 7.9% to - 5.2%) and for the ratio of consumption of broad- to narrow-spectrum penicillins, cephalosporins, and macrolides - 9.0% (95% CI: - 14.0 to - 4.1%). The cost of the intervention was €87 per physician. Direct savings per physician attributable to the reduction in antibiotic prescriptions was €311 for the NHS and €573 for patient contributions, with an ROI of €2.57 and €5.59 respectively.
conclusionsInterventions designed on the basis of gaps in physicians' knowledge of and attitudes to misprescription can improve antibiotic prescribing and yield important direct cost savings.
trial registrationCurrent Controlled Trials ISRCTN24158380 . Registered 5 February 2009.
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