A RCT evaluating the effectiveness and cost-effectiveness of academic detailing versus postal prescribing feedback in changing GP antibiotic prescribing
Abstract
PURPOSE: The aim of this study is to evaluate the effectiveness of academic detailing (AD) plus postal prescribing feedback versus postal prescribing feedback alone in reducing: (i) the overall rate of antibiotic; and (ii) proportion of second-line antibiotic prescribing. In addition, the cost-effectiveness of an outreach prescriber adviser service versus a postal prescribing feedback service was evaluated. METHODS: Volunteer general practitioner practices (n = 98) were randomized to receive prescribing feedback via postal bulletin (PB) (n = 50) or academic detailing plus postal bulletin (AD) (n = 48). Data analysis was based on the HSE-primary care reimbursement service (HSE-PCRS) prescribing database. Regression (beta) coefficients, indicating proportion change in prescribing per month, and 95% confidence intervals (CIs) are presented. The cost-effectiveness ratio was calculated from the total cost of the intervention divided by percentage change in antibiotic prescribing in AD versus PB group. RESULTS: Immediately post intervention PB (beta = -0.02, 95% CI -0.04, -0.001) and AD (beta = -0.02, 95% CI -0.03, -0.001) practices significantly decreased overall antibiotic prescribing. Second-line antibiotic prescribing was also significantly decreased by 2-3% in both groups. However, there were no significant differences in antibiotic prescribing between the randomized groups in the immediate or long-term post-intervention period. In the cost-effectiveness analysis a postal prescribing feedback service would cost euro 88 per percentage change in prescribing practice compared with euro 778 for a prescriber adviser service. CONCLUSION: Prescribing feedback significantly reduced overall and second-line antibiotic prescribing, but academic detailing was not significantly more effective than postal bulletin in changing antibiotic prescribing practice.
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Naughton 2009 found no statistically significant effect on antibiotic prescribing in primary care (adjusted change relative to baseline performance in the audit and feedback alone arm = 0%; P = 0.33).
“antibiotic prescribing in primary care (Naughton 2009: adjusted change relative to baseline performance in the audit and feedback alone arm = 0%; P = 0.33)”
From Audit and feedback: effects on professional practice and healthcare outcomes (2012) · cites this paper as Naughton 2009
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- Authors
- Naughton, C., Feely, J., & Bennett, K.
- Affiliations
- University College Dublin (IE)
- Trinity College Dublin (IE)
- Corresponding author
- Naughton, Corina
- Venue
- Journal of Evaluation in Clinical Practice
- Publisher
- Wiley
- Published
- 2009-09-24
- Volume
- 15
- Issue
- 5
- Pages
- 807-812
- ISSN
- 1356-1294 (ISSN-L)
- 1365-2753
- OpenAlex
- W1994239676
- Cited by
- 49
- References
- 33
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 3 · 2023: 2 · 2022: 4 · 2021: 3 · 2020: 4 · 2019: 1 · 2018: 2 · 2017: 4 · 2016: 3 · 2015: 3 · 2014: 3 · 2013: 2 · 2012: 6
- FWCI
- 5.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Evaluation in Clinical Practice (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Lenus, The Irish Health Repository (Dr Steevens Hospital Library) (submittedVersion)
- 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 › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- academic detailing, prescribing feedback, antibiotic prescribing, second-line antibiotics, general practitioners, cost-effectiveness, primary care prescribing
- MeSH terms
- Anti-Bacterial Agents, Cost-Benefit Analysis, Drug Resistance, Microbial, Feedback, Humans, Ireland, Practice Patterns, Physicians', Physicians, Family, Postal Service, Drug Prescriptions, Program Evaluation, Databases as Topic, Methicillin-Resistant Staphylococcus aureus
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