Cluster randomised controlled trial of tailored interventions to improve the management of urinary tract infections in women and sore throat
Open accessAbstract
Objective :To assess the effectiveness of tailored interventions to implement guidelines for urinary tract infections in women and sore throat Design :Unblinded, cluster randomised pretest-post-test trial Setting :142 general practices in Norway Participants :72 practices received interventions to implement guidelines for urinary tract infection and 70 practices received interventions to implement guidelines for sore throat, serving as controls for each other. 59 practices in the urinary tract infection group and 61 practices in the sore throat group completed the study. Outcomes were measured in 16 939 consultations for sore throat and 9887 consultations for urinary tract infection. Interventions :Interventions were developed to overcome identified barriers to implementing the guidelines. The main components of the tailored interventions were patient educational material, computer based decision support and reminders, an increase in the fee for telephone consultations, and interactive courses for general practitioners and practice assistants Main outcome measures :Changes in rates of use of antibiotics, laboratory tests, and telephone consultations Results :Patients in the sore throat group were 3% less likely to receive antibiotics after the intervention. Women with symptoms of urinary tract infection in the intervention group were 5.1% less likely to have a laboratory test ordered. No significant differences were found between the groups for the other outcomes. Large variation was found across the included practicesin the rates of antibiotic prescription, use of laboratory tests and telephone consultations, and in the extent of change for all three outcome measures Conclusions :Passively delivered, complex interventions targeted at identified barriers to change had little effect in changing practice
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For the seven studies that received no control intervention, the pooled odds ratio was 1.36 (95% CI 0.92 to 1.99, P = 0.099).
“Of these, seven were suitable for inclusion in a meta‐regression, and the pooled odds ratio for the seven studies that received no control intervention was 1.36 (95% CI 0.92 to 1.99, P value = 0.099) (Avorn 1992; Callahan 1994; Flottorp 2002; Looijmans 2010; Murphy 2009; Scott 2013; Schouten 2007).”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Flottorp 2002
The overall risk of bias for Flottorp 2002 was unclear.
“Risk of bias overall Unclear risk Allocation concealment”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Flottorp 2002
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Self-citation
- Authors
- Flottorp, S., Oxman, A. D., Håvelsrud, K., Treweek, S., & Herrin, J.
- Affiliations
- Norwegian Directorate of Health (NO)
- Corresponding author
- Flottorp, Signe
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2002-08-17
- Volume
- 325
- Issue
- 7360
- Pages
- 367
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC117890
- OpenAlex
- W2146745032
- Cited by
- 154
- References
- 25
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 7 · 2023: 1 · 2022: 1 · 2021: 9 · 2020: 7 · 2019: 1 · 2018: 5 · 2017: 5 · 2016: 13 · 2015: 8 · 2014: 7 · 2013: 8 · 2012: 8
- FWCI
- 23.26
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
- Locations
- BMJ (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Discovery Research Portal (University of Dundee) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Keywords
- urinary tract infection, sore throat, guideline implementation, personalized interventions, general practice, antibiotic prescribing, telephone consultation, computer-based decision support, patient education, barriers to change, primary care
- MeSH terms
- Adolescent, Adult, Family Practice, Female, Humans, Middle Aged, Norway, Pharyngitis, Practice Patterns, Physicians', Quality of Health Care, Referral and Consultation, Urinary Tract Infections, Cluster Analysis, Logistic Models, Treatment Outcome, Practice Guidelines as Topic, Clinical Laboratory Techniques
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