Evidence map›Paper›PMID 39559165›Full record

ArticleThe Lancet regional health. Western Pacific2024

A complex intervention to reduce antibiotic prescribing in rural China: a cluster randomised controlled trial.

Xingrong Shen, Beth Stuart, Enci Cui, Rong Liu, Tingting Zhang, Jing Chai, Wenjuan Cong, Xiaowen Hu, Isabel Oliver, Guiqing Yao and 5 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Lancet regional health. Western Pacific, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–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

3 citing papers in PubMed.

  1. Trial
  2. Trial
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Xingrong ShenSchool of Health Service Management, Anhui Medical University, Hefei Anhui 230032, China.
Beth StuartWolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, Yvonne Carter Building, London, UK.
Enci CuiSchool of Health Service Management, Anhui Medical University, Hefei Anhui 230032, China.
Rong LiuSchool of Health Service Management, Anhui Medical University, Hefei Anhui 230032, China.
Tingting ZhangPopulation Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
Jing ChaiSchool of Health Service Management, Anhui Medical University, Hefei Anhui 230032, China.
Wenjuan CongPopulation Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
Xiaowen HuDepartment of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China.
Isabel OliverUK Health Security Agency, Bristol, UK.
Guiqing YaoDepartment of Health Sciences, University of Leicester, Leicester, England, UK.
Paul LittlePrimary Care Research Centre, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, SO16 5ST, UK.
Helen LambertPopulation Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
Lucy YardleySchool of Psychological Science, University of Bristol, 12A Priory Rd, Bristol, BS8 1TU, UK.
Christie CabralPopulation Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
Debin WangSchool of Health Service Management, Anhui Medical University, Hefei Anhui 230032, China.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Excessive use of antibiotics is a widespread problem. We aim to evaluate the efficacy of a multifaceted intervention for reducing antibiotic use in patients with respiratory tract infections (RTIs). Methods: In this two-arm cluster randomized controlled trial, we enrolled patients aged 18+ with symptomatic RTIs at 40 township health centers (THCs) selected from 10 counties in Anhui, China. The THCs were randomized using an online tool ('Sealed Envelope') to intervention or usual care (1:1 ratio), stratified by baseline antibiotic prescribing and with random block sizes (4 or 6). The intervention had five components: a half-day clinician training, a WeChat-based peer support group, a decision aid, a poster commitment letter and a patient leaflet. The primary outcome was whether antibiotics were prescribed at the index consultation. Secondary measures included defined daily dose (DDD), illness recovery rate, re-visits to other care-givers or retail pharmacies and incremental cost-effectiveness ratio (ICER). These measures were analyzed using generalized linear mixed modeling controlling for clustering. The study was registered as ISRCTN30652037. Findings: Between December 2021 and September 2022, 1053 patients were recruited (intervention, 21 THCs, n = 552; control, 19 THCs, n = 501), using consecutive sampling. Antibiotic prescribing rate was 55.25% and 66.67% in the intervention and control arms (Odds ratio 0.52, 95% confidence interval [CI]: 0.27, 0.98; p = 0.044). The intervention group also had lower, significant or non-significant, differences for other markers of antibiotic use: DDD (1.57 vs 2.75); prescriptions of two or more types of antibiotics (9.78% vs 11.58%); obtaining antibiotics from retail pharmacies (3.68% vs 5.78) or from other clinics (2.70% vs 4.05%). The intervention resulted in a cost reduction of 9.265 RMB (1.471 USD) per consultation episode and an ICER of -7769.98 RMB or -1233.33 USD/QALYs. The intervention did not encounter any major adverse event. Interpretation: The intervention package was effective and cost-effective in reducing antibiotics prescribing without adverse effects. Funding: The trial was supported by National Natural Science Foundation of China (No. 81861138049) and United Kingdom Research Innovation (No. MR/S013717/1).

Indexed as

AntibioticsChinaCluster randomised controlled trialPrescribingPrimary careRespiratory infection

Identifiers

PMID39559165
PMCPMC11570860

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.