Intervention to improve the quality of antimicrobial prescribing for urinary tract infection: a cluster randomized trial

Abstract

Interpretation: A complex intervention, including audit reports and reminders, improved the quality of prescribing for urinary tract infection in Irish general practice. Trial registration: ClinicalTrials.gov, no. NCT01913860 AbstractSee also page 94 and www.cmaj.ca/lookup

Why did some practices not implement new antibiotic prescribing guidelines on urinary tract infection? A cohort study and survey in NHS England primary care

“…11 One study in Ireland found that practices with interventions including interactive workshops and decision support system prompts were more likely to prescribe nitrofurantoin first line. 12 A Cochrane review into the use of financial incentivisation of prescribing concluded there is little evidence of benefit in the use of financial incentives to improve prescribing. 13 The NHS has invested extensively in "medicines optimisation" activity, where teams of pharmacists in every CCG monitor prescribing behaviour and advocate for change with individual clinicians.…”

Changing antibiotic prescribing in General Practice – The results of the SIMPle process evaluation

“…The outcome evaluation highlighted GPs had continued to code 5 months after the intervention had concluded. [15] Cumulative frequencies included within practice audit and feedback reports provided further evidence that practices continuously coded consultations throughout the intervention period and beyond. The follow up evaluation provided further evidence that GPs continued to code.…”

“…[14,15] The study's CONSORT diagram is provided in Figure 1. SIMPle's primary outcome was to increase the number of first-line antibiotic prescriptions, as recommended in the Guidelines for Antimicrobial Prescribing in Primary Care in Ireland (2011), for suspected UTIs in primary care by 10% in adult patients.…”

“…[14] The SIMPle study achieved an increase in first line prescriptions for UTI consultation by 20 absolute percentage points. [15] The SIMPle study illustrates the positive impact complex interventions integrated into routine care can have on antibiotics prescribing behaviour. [15] However, upon further analysis the results of the SIMPle study indicate two unintended outcomes.…”

“…[15] The SIMPle study illustrates the positive impact complex interventions integrated into routine care can have on antibiotics prescribing behaviour. [15] However, upon further analysis the results of the SIMPle study indicate two unintended outcomes. There was an increase in overall antibiotic prescriptions during the intervention period and GPs were less likely to switch from non-first line antibiotic treatments to the recommended nitrofurantoin than from trimethoprim (a first line treatment with high community resistance) to nitrofurantoin.…”