Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial
Open accessAbstract
Background High-volume prescribing of antibiotics in primary care is a major driver of antibiotic resistance. Education of physicians and patients can lower prescribing levels, but it frequently relies on highly trained staff. We assessed whether internet-based training methods could alter prescribing practices in multiple health-care systems.Methods After a baseline audit in October to December, 2010, primary-care practices in six European countries were cluster randomised to usual care, training in the use of a C-reactive protein (CRP) test at point of care, in enhanced communication skills, or in both CRP and enhanced communication. Patients were recruited from February to May, 2011. This trial is registered, number ISRCTN99871214.Results The baseline audit, done in 259 practices, provided data for 6771 patients with lower-respiratory-tract infections (3742 [55·3%]) and upper-respiratory-tract infections (1416 [20·9%]), of whom 5355 (79·1%) were prescribed antibiotics. After randomisation, 246 practices were included and 4264 patients were recruited. The antibiotic prescribing rate was lower with CRP training than without (33% vs 48%, adjusted risk ratio 0·54, 95% CI 0·42-0·69) and with enhanced-communication training than without (36% vs 45%, 0·69, 0·54-0·87). The combined intervention was associated with the greatest reduction in prescribing rate (CRP risk ratio 0·53, 95% CI 0·36-0·74, p<0·0001; enhanced communication 0·68, 0·50-0·89, p=0·003; combined 0·38, 0·25-0·55, p<0·0001).Interpretation Internet training achieved important reductions in antibiotic prescribing for respiratory-tract infections across language and cultural boundaries.Funding European Commission Framework Programme 6, National Institute for Health Research, Research Foundation Flanders.
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Interventions developed using the person-based approach have proven effective in trials involving tens of thousands of users.
“interventions that have proven effective in trials involving tens of thousands of users.”
From The Person-Based Approach to Intervention Development: Application to Digital Health-Related Behavior Change Interventions (2015) · cites this paper as [19]
An online intervention supporting diagnostic tests and an in-house seminar proved very acceptable and successful across six European countries.
“This intervention proved very acceptable [44] and successful [45] across six European countries.”
From The Person-Based Approach to Intervention Development: Application to Digital Health-Related Behavior Change Interventions (2015) · cites this paper as [45]
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Self-citation
- Authors
- Little, P., Stuart, B., Francis, N., Douglas, E., Tonkin-Crine, S., Anthierens, S., Cals, J. W., Melbye, H., Santer, M., Moore, M., Coenen, S., Butler, C., Hood, K., Kelly, M., Godycki-Cwirko, M., Mierzecki, A., Torres, A., Llor, C., Davies, M., Mullee, M., O'Reilly, G., van der Velden, A., Geraghty, A. W., Goossens, H., Verheij, T., & Yardley, L.
- Affiliations
- University of Southampton (GB)
- Cardiff University (GB)
- Utrecht University (NL)
- University of Antwerp (BE)
- Maastricht University (NL)
- UiT The Arctic University of Norway (NO)
- Pomeranian Medical University (PL)
- Sociedad Española de Medicina de Familia y Comunitaria (ES)
- University Medical Center Utrecht (NL)
- Corresponding author
- Little, Paul
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2013-10
- Volume
- 382
- Issue
- 9899
- Pages
- 1175-1182
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC3807804
- OpenAlex
- W2172218385
- Cited by
- 430
- References
- 29
- Citations by year
- 2026: 19 · 2025: 26 · 2024: 24 · 2023: 22 · 2022: 36 · 2021: 35 · 2020: 67 · 2019: 34 · 2018: 29 · 2017: 36 · 2016: 41 · 2015: 26 · 2014: 28 · 2013: 7
- FWCI
- 30.14
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- The Lancet (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Stirling Online Research Repository (University of Stirling) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- ePrints Soton (University of Southampton) (submittedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion)
- Funders
- European Commission Framework 6 Programme (518226)
- National Institute for Health Research and the Research Foundation Flanders (G.0274.08N)
- Topics
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
- Keywords
- antibiotic prescribing, internet-based training, primary care, acute respiratory infections, C-reactive protein testing, point-of-care testing, communication skills training, antibiotic resistance, lower respiratory tract infection, upper respiratory tract infection, physician training
- MeSH terms
- Acute Disease, Anti-Bacterial Agents, C-Reactive Protein, Clinical Competence, Communication, Europe, Female, Humans, Inservice Training, Male, Middle Aged, Practice Patterns, Physicians', Primary Health Care, Respiratory Tract Infections, Teaching, Cluster Analysis, Point-of-Care Systems, Internet, General Practice
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