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Feedback of Antibiotic Prescribing in Primary Care (FAPPC) trial : results of a real-world cluster randomized controlled trial in Scotland, UK
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Marwick, Charis A, Hossain, Anower, Nogueira, Rita, Sneddon, Jacqueline, Kavanagh, Kim, Bennie, Marion, Seaton, R Andrew, Guthrie, Bruce and Malcolm, William (2022) Feedback of Antibiotic Prescribing in Primary Care (FAPPC) trial : results of a real-world cluster randomized controlled trial in Scotland, UK. Journal of Antimicrobial Chemotherapy, 77 (12). pp. 3291-3300. doi:10.1093/jac/dkac317 ISSN 0305-7453.
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Official URL: http://dx.doi.org/10.1093/jac/dkac317
Abstract
Objectives
To evaluate the effect of general practice-level prescribing feedback on antibiotic prescribing in a real-world pragmatic cluster randomized controlled trial
Methods
Three hundred and forty general practices in four territorial Health Boards in NHS Scotland were randomized in Quarter 1, 2016 to receive four quarterly antibiotic-prescribing feedback reports or not, from Quarter 2, 2016 to Quarter 1, 2017. Reports included different clinical topics, benchmarking against national and health board rates, and behavioural messaging with improvement actions. The primary outcome was total antibiotic prescribing rate. There were 16 secondary prescribing outcomes and 5 hospital admission outcomes (potential adverse effects of reduced prescribing). The main evaluation timepoint was 1 year after the final report (Quarter 1, 2018), with an additional evaluation in the quarter after the final report (Quarter 2, 2017). Routine administrative NHS data were used to generate the feedback reports and analyse the effects.
Results
Total antibiotic prescribing rates were lower at the main evaluation timepoint in both intervention (1.83 versus baseline 1.93 prescriptions/1000 patients/day) and control (1.90 versus baseline 1.98) practices, with no evidence of intervention effect [adjusted rate ratio (ARR) 0.98 (95% CI 0.94–1.02; P = 0.35)]. At the additional timepoint, adjusted total antibiotic prescribing rates were 1.67 and 1.73 prescriptions/1000 patients/day, with evidence of a small intervention effect, ARR 0.99 (0.98–1.00; P = 0.03).
Conclusions
This well-designed, practice-level antibiotic-prescribing feedback had limited evidence of additional effects in the context of decreasing antibiotic prescribing and an established national stewardship programme.
| Item Type: | Journal Article | ||||||||
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| Subjects: | Q Science > QR Microbiology R Medicine > R Medicine (General) R Medicine > RA Public aspects of medicine R Medicine > RM Therapeutics. Pharmacology R Medicine > RS Pharmacy and materia medica |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||||
| Library of Congress Subject Headings (LCSH): | Antibiotics , Medicine -- Formulae, receipts, prescriptions, Primary care (Medicine) -- Scotland, Clinical trials -- Scotland, Drug resistance in microorganisms | ||||||||
| Journal or Publication Title: | Journal of Antimicrobial Chemotherapy | ||||||||
| Publisher: | Oxford University Press | ||||||||
| ISSN: | 0305-7453 | ||||||||
| Official Date: | December 2022 | ||||||||
| Dates: |
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| Volume: | 77 | ||||||||
| Number: | 12 | ||||||||
| Page Range: | pp. 3291-3300 | ||||||||
| DOI: | 10.1093/jac/dkac317 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||||
| Date of first compliant deposit: | 25 January 2023 | ||||||||
| Date of first compliant Open Access: | 25 January 2023 | ||||||||
| RIOXX Funder/Project Grant: |
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