Let’s Talk About Antibiotics: a randomised trial of two interventions to reduce antibiotic misuse
Background Children with acute respiratory tract infections (ARTIs) receive ≈11.4 million unnecessary antibiotic prescriptions annually. A noted contributor is inadequate parent–clinician communication, however, efforts to reduce overprescribing have only indirectly targeted communication or been im...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/11/e049258.full |
| _version_ | 1811308813712621568 |
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| author | Emily A Hurley Kathy Goggin Christopher C Butler Andrea Bradley-Ewing Angela L Myers Brian R Lee Kimberly Pina David Yu Kirsten Weltmer Sebastian Linnemayr Jason G Newland Carey Bickford Evelyn Donis de Miranda |
| author_facet | Emily A Hurley Kathy Goggin Christopher C Butler Andrea Bradley-Ewing Angela L Myers Brian R Lee Kimberly Pina David Yu Kirsten Weltmer Sebastian Linnemayr Jason G Newland Carey Bickford Evelyn Donis de Miranda |
| author_sort | Emily A Hurley |
| collection | DOAJ |
| description | Background Children with acute respiratory tract infections (ARTIs) receive ≈11.4 million unnecessary antibiotic prescriptions annually. A noted contributor is inadequate parent–clinician communication, however, efforts to reduce overprescribing have only indirectly targeted communication or been impractical.Objectives Compare two feasible (higher vs lower intensity) interventions for enhancing parent–clinician communication on the rate of inappropriate antibiotic prescribing.Design Multisite, parallel group, cluster randomised comparative effectiveness trial. Data collected between March 2017 and March 2019.Setting Academic and private practice outpatient clinics.Participants Clinicians (n=41, 85% of eligible approached) and 1599 parent–child dyads (ages 1–5 years with ARTI symptoms, 71% of eligible approached).Interventions All clinicians received 20 min ARTI diagnosis and treatment education. Higher intensity clinicians received an additional 50 min communication skills training. All parents viewed a 90 second antibiotic education video.Main outcome(s) and measure(s) Inappropriate antibiotic treatment was assessed via blinded medical record review by study clinicians and a priori defined as prescriptions for the wrong diagnosis or use of the wrong agent. Secondary outcomes were revisits, adverse drug reactions (both assessed 2 weeks after the visit) and parent ratings of provider communication, shared decision-making and visit satisfaction (assessed at end of the visit on Likert-type scales).Results Most clinicians completed the study (n=38, 93%), were doctors (n=25, 66%), female (n=30, 78%) and averaged 8 years in practice. All parent–child dyad provided data for the main outcome (n=855 (54%) male, n=1043 (53%) <2 years). Inappropriate antibiotic prescribing was similar among patients who consulted with a higher intensity (54/696, 7.8%) versus a lower intensity (85/904, 9.4%) clinician. A generalised linear mixed effect regression model (adjusted for the two-stage nested design, clinician type, clinic setting and clinician experience) revealed that the odds of receiving inappropriate antibiotic treatment did not significantly vary by group (AOR 0.99, 95% CI: 0.52 to 1.89, p=0.98). Secondary outcomes of revisits and adverse reactions did not vary between arms, and parent ratings of satisfaction with quality of parent–provider communication (5/5), shared decision making (9/10) and visit satisfaction (5/5) were similarly high in both arms.Conclusions and relevance Rate of inappropriate prescribing was low in both arms. Clinician education coupled with parent education may be sufficient to yield low inappropriate antibiotic prescribing rates. The absence of a significant difference between groups indicates that communication principles previously thought to drive inappropriate prescribing may need to be re-examined or may not have as much of an impact in practices where prescribing has improved in recent years.Trial registration number NCT03037112. |
| first_indexed | 2024-04-13T09:29:53Z |
| format | Article |
| id | doaj.art-3a1bc6ba5ca5416fb2911a75943756fe |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-04-13T09:29:53Z |
| publishDate | 2022-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-3a1bc6ba5ca5416fb2911a75943756fe2022-12-22T02:52:17ZengBMJ Publishing GroupBMJ Open2044-60552022-11-01121110.1136/bmjopen-2021-049258Let’s Talk About Antibiotics: a randomised trial of two interventions to reduce antibiotic misuseEmily A Hurley0Kathy Goggin1Christopher C Butler2Andrea Bradley-Ewing3Angela L Myers4Brian R Lee5Kimberly Pina6David Yu7Kirsten Weltmer8Sebastian Linnemayr9Jason G Newland10Carey Bickford11Evelyn Donis de Miranda12Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USADepartment of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA4 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK1 Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, Kansas City, Missouri, USA2 School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA1 Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, Kansas City, Missouri, USA1 Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, Kansas City, Missouri, USA5 Sunflower Medical Group, Kansas City, Kansas, USA2 School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA6 RAND Corporation, Santa Monica, California, USA8 Pediatric Infectious Disease, St. Louis Children’s Hospital, St. Louis, Missouri, USAHealth Services and Outcomes Research, Children`s Mercy Hospitals and Clinics, Kansas City, Missouri, USAHealth Services and Outcomes Research, Children`s Mercy Hospitals and Clinics, Kansas City, Missouri, USABackground Children with acute respiratory tract infections (ARTIs) receive ≈11.4 million unnecessary antibiotic prescriptions annually. A noted contributor is inadequate parent–clinician communication, however, efforts to reduce overprescribing have only indirectly targeted communication or been impractical.Objectives Compare two feasible (higher vs lower intensity) interventions for enhancing parent–clinician communication on the rate of inappropriate antibiotic prescribing.Design Multisite, parallel group, cluster randomised comparative effectiveness trial. Data collected between March 2017 and March 2019.Setting Academic and private practice outpatient clinics.Participants Clinicians (n=41, 85% of eligible approached) and 1599 parent–child dyads (ages 1–5 years with ARTI symptoms, 71% of eligible approached).Interventions All clinicians received 20 min ARTI diagnosis and treatment education. Higher intensity clinicians received an additional 50 min communication skills training. All parents viewed a 90 second antibiotic education video.Main outcome(s) and measure(s) Inappropriate antibiotic treatment was assessed via blinded medical record review by study clinicians and a priori defined as prescriptions for the wrong diagnosis or use of the wrong agent. Secondary outcomes were revisits, adverse drug reactions (both assessed 2 weeks after the visit) and parent ratings of provider communication, shared decision-making and visit satisfaction (assessed at end of the visit on Likert-type scales).Results Most clinicians completed the study (n=38, 93%), were doctors (n=25, 66%), female (n=30, 78%) and averaged 8 years in practice. All parent–child dyad provided data for the main outcome (n=855 (54%) male, n=1043 (53%) <2 years). Inappropriate antibiotic prescribing was similar among patients who consulted with a higher intensity (54/696, 7.8%) versus a lower intensity (85/904, 9.4%) clinician. A generalised linear mixed effect regression model (adjusted for the two-stage nested design, clinician type, clinic setting and clinician experience) revealed that the odds of receiving inappropriate antibiotic treatment did not significantly vary by group (AOR 0.99, 95% CI: 0.52 to 1.89, p=0.98). Secondary outcomes of revisits and adverse reactions did not vary between arms, and parent ratings of satisfaction with quality of parent–provider communication (5/5), shared decision making (9/10) and visit satisfaction (5/5) were similarly high in both arms.Conclusions and relevance Rate of inappropriate prescribing was low in both arms. Clinician education coupled with parent education may be sufficient to yield low inappropriate antibiotic prescribing rates. The absence of a significant difference between groups indicates that communication principles previously thought to drive inappropriate prescribing may need to be re-examined or may not have as much of an impact in practices where prescribing has improved in recent years.Trial registration number NCT03037112.https://bmjopen.bmj.com/content/12/11/e049258.full |
| spellingShingle | Emily A Hurley Kathy Goggin Christopher C Butler Andrea Bradley-Ewing Angela L Myers Brian R Lee Kimberly Pina David Yu Kirsten Weltmer Sebastian Linnemayr Jason G Newland Carey Bickford Evelyn Donis de Miranda Let’s Talk About Antibiotics: a randomised trial of two interventions to reduce antibiotic misuse BMJ Open |
| title | Let’s Talk About Antibiotics: a randomised trial of two interventions to reduce antibiotic misuse |
| title_full | Let’s Talk About Antibiotics: a randomised trial of two interventions to reduce antibiotic misuse |
| title_fullStr | Let’s Talk About Antibiotics: a randomised trial of two interventions to reduce antibiotic misuse |
| title_full_unstemmed | Let’s Talk About Antibiotics: a randomised trial of two interventions to reduce antibiotic misuse |
| title_short | Let’s Talk About Antibiotics: a randomised trial of two interventions to reduce antibiotic misuse |
| title_sort | let s talk about antibiotics a randomised trial of two interventions to reduce antibiotic misuse |
| url | https://bmjopen.bmj.com/content/12/11/e049258.full |
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