Imperial College London
Alternate

Professor Toby Prevost

Faculty of Medicine, School of Public Health

Visiting Professor
 
 
 
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Contact

 

a.prevost

 
 
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Location

 

57Stadium HouseWhite City Campus

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Summary

 

Publications

Citation

BibTex format

@article{Gulliford:2019:10.1136/bmj.l236,
author = {Gulliford, M and Prevost, A and Charlton, J and Juszczyk, D and Soames, J and McDermott, L and Sultana, K and Wright, M and Fox, R and Hay, A and Little, P and Moore, M and Yardley, L and Ashworth, M},
doi = {10.1136/bmj.l236},
journal = {BMJ},
title = {Effectiveness and safety of electronically-delivered prescribing feedback and decision support on antibiotic utilisation for respiratory illness in primary care. REDUCE cluster-randomised trial},
url = {http://dx.doi.org/10.1136/bmj.l236},
volume = {364},
year = {2019}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Objectives To evaluate the effectiveness and safety at population scale of electronically delivered prescribing feedback and decision support interventions at reducing antibiotic prescribing for self limiting respiratory tract infections.Design Open label, two arm, cluster randomised controlled trial.Setting UK general practices in the Clinical Practice Research Datalink, randomised between 11 November 2015 and 9 August 2016, with final follow-up on 9 August 2017.Participants 79 general practices (582 675 patient years) randomised (1:1) to antimicrobial stewardship (AMS) intervention or usual care.Interventions AMS intervention comprised a brief training webinar, automated monthly feedback reports of antibiotic prescribing, and electronic decision support tools to inform appropriate prescribing over 12 months. Intervention components were delivered electronically, supported by a local practice champion nominated for the trial.Main outcome measures Primary outcome was the rate of antibiotic prescriptions for respiratory tract infections from electronic health records. Serious bacterial complications were evaluated for safety. Analysis was by Poisson regression with general practice as a random effect, adjusting for covariates. Prespecified subgroup analyses by age group were reported.Results The trial included 41 AMS practices (323 155 patient years) and 38 usual care practices (259 520 patient years). Unadjusted and adjusted rate ratios for antibiotic prescribing were 0.89 (95% confidence interval 0.68 to 1.16) and 0.88 (0.78 to 0.99, P=0.04), respectively, with prescribing rates of 98.7 per 1000 patient years for AMS (31 907 prescriptions) and 107.6 per 1000 patient years for usual care (27 923 prescriptions). Antibiotic prescribing was reduced most in adults aged 15-84 years (adjusted rate ratio 0.84, 95% confidence interval 0.75 to 0.95), with one antibiotic prescription per year avoided for every 62 patients (95% confide
AU  - Gulliford,M
AU  - Prevost,A
AU  - Charlton,J
AU  - Juszczyk,D
AU  - Soames,J
AU  - McDermott,L
AU  - Sultana,K
AU  - Wright,M
AU  - Fox,R
AU  - Hay,A
AU  - Little,P
AU  - Moore,M
AU  - Yardley,L
AU  - Ashworth,M
DO  - 10.1136/bmj.l236
PY  - 2019///
SN  - 0959-8138
TI  - Effectiveness and safety of electronically-delivered prescribing feedback and decision support on antibiotic utilisation for respiratory illness in primary care. REDUCE cluster-randomised trial
T2  - BMJ
UR  - http://dx.doi.org/10.1136/bmj.l236
UR  - http://hdl.handle.net/10044/1/66928
VL  - 364
ER  -
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