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Title: Long-term effect of a practice-based intervention (HAPPY AUDIT) aimed at reducing antibiotic prescribing in patients with respiratory tract infections
Authors: Llor, Carl
Bjerrum, Lars
Molero, Jose M.
Moragas, Ana
González Lopez-Valcarcel, Beatriz 
Jose Monedero, M.
Gomez, Manuel
Cid, Marina
de Dios Alcantara, Juan
Cots, Josep M.
Ribas, Joana M.
Garcia, Guillermo
Ortega, Jesus
Pineda, Vicenta
Guerra, Gloria
Munuera, Susana
HAPPY AUDIT 3 Study Team
Keywords: 531207 Sanidad
metadata.dc.subject.other: Antibiotics
Respiratory tract infections
Prescribing behavior
Appropriate use
Issue Date: 2018
Publisher: 0305-7453
Journal: Journal of Antimicrobial Chemotherapy 
Abstract: Objectives Few studies have evaluated the long-term effects of educational interventions on antibiotic prescription and the results are controversial. This study was aimed at assessing the effect of a multifaceted practice-based intervention carried out 6 years earlier on current antibiotic prescription for respiratory tract infections (RTIs). Methods The 210 general practitioners (GPs) who completed the first two registrations in 2008 and 2009 were invited to participate in a third registration. The intervention held before the second registration consisted of discussion about the first registration of results, appropriate use of antibiotics for RTIs, patient brochures, a workshop and the provision of rapid tests. As in the previous registrations, GPs were instructed to complete a template for all the patients with RTIs during 15 working days in 2015. A new group of GPs from the same areas was also invited to participate and acted as controls. A multilevel logistic regression analysis was performed considering the prescription of antibiotics as the dependent variable. Results A total of 121 GPs included in the 2009 intervention (57.6%) and 117 control GPs registered 22 247 RTIs. On adjustment for covariables, compared with the antibiotic prescription observed just after the intervention, GPs assigned to intervention prescribed slightly more antibiotics 6 years later albeit without statistically significant differences (OR 1.08, 95% CI 0.89–1.31, P = 0.46), while GPs in the control group prescribed significantly more antibiotics (OR 2.74, 95% CI 2.09–3.59, P < 0.001). Conclusions This study shows that a single multifaceted intervention continues to reduce antibiotic prescribing 6 years later.
ISSN: 0305-7453
DOI: 10.1093/jac/dky137
Source: Journal of Antimicrobial Chemotherapy [ISSN 0305-7453], v. 73 (8), p. 2215-2222
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