RT Journal Article
T1 Impact of a multifaceted intervention to improve antibiotic prescribing: a pragmatic cluster-randomised controlled trial
A1 Figueiras Guzmán, Adolfo
A1 López Vázquez, Paula María
A1 González‑González, Cristian
A1 Vázquez Lago, Juan M.
A1 Piñeiro-Lamas, María
A1 López Durán, Ana
A1 Sánchez, Coro
A1 Herdeiro, Maria Teresa Ferreira
A1 Zapata Cachafeiro, Maruxa
A1 GREPHEPI Group, 
K1 Primary care
K1 Physicians
K1 Attitudes
K1 Microbial resistances
K1 Antibiotics
K1 Inappropriate prescribing
K1 Educational intervention
AB ObjectivesThis study sought to assess the effectiveness and return on investment (ROI) of a multifaceted intervention aimed at improving antibiotic prescribing for acute respiratory infections in primary care.DesignLarge-sized, two-arm, open-label, pragmatic, cluster-randomised controlled trial.SettingAll primary care physicians working for the Spanish National Health Service (NHS) in Galicia (region in north-west Spain).ParticipantsThe seven spatial clusters were distributed by unequal randomisation (3:4) of the intervention and control groups. A total of 1217 physicians (1.30 million patients) were recruited from intervention clusters and 1393 physicians (1.46 million patients) from control clusters.InterventionsOne-hour educational outreach visits tailored to training needs identified in a previous study; an online course integrated in practice accreditation; and a clinical decision support system.Main outcome measuresChanges in the ESAC (European Surveillance of Antimicrobial Consumption) quality indicators for outpatient antibiotic use. We used generalised linear mixed and conducted a ROI analysis to ascertain the overall cost savings.ResultsMedian follow-up was 19 months. The adjusted effect on overall antibiotic prescribing attributable to the intervention was − 4.2% (95% CI: − 5.3% to − 3.2%), with this being more pronounced for penicillins − 6.5 (95% CI: − 7.9% to − 5.2%) and for the ratio of consumption of broad- to narrow-spectrum penicillins, cephalosporins, and macrolides − 9.0% (95% CI: − 14.0 to − 4.1%). The cost of the intervention was €87 per physician. Direct savings per physician attributable to the reduction in antibiotic prescriptions was €311 for the NHS and €573 for patient contributions, with an ROI of €2.57 and €5.59 respectively.ConclusionsInterventions designed on the basis of gaps in physicians’ knowledge of and attitudes to misprescription can improve antibiotic prescribing and yield important direct cost savings
PB Springer Nature
SN 2047-2994
YR 2020
FD 2020
LK http://hdl.handle.net/10347/27324
UL http://hdl.handle.net/10347/27324
LA eng
NO Figueiras, López-Vázquez, P., Gonzalez-Gonzalez, C. et al. Impact of a multifaceted intervention to improve antibiotic prescribing: a pragmatic cluster-randomised controlled trial. Antimicrob Resist Infect Control 9, 195 (2020)
NO This work was supported in part by the Instituto de Salud Carlos III (ISCII) (PI081239, PI09/90609, PI19/01006) Spanish State Plan for Scientific and Technical Research and Innovation 2012–2016 and 2017–2020, co-financed by The European Regional Development Fund (ERDF) and the Mutua Madrileña insurance company
DS Minerva
RD 28 abr 2026