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http://hdl.handle.net/10773/31077
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DC Field | Value | Language |
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dc.contributor.author | Figueiras, Adolfo | pt_PT |
dc.contributor.author | López-Vázquez, Paula | pt_PT |
dc.contributor.author | Gonzalez-Gonzalez, Cristian | pt_PT |
dc.contributor.author | Vázquez-Lago, Juan Manuel | pt_PT |
dc.contributor.author | Piñeiro-Lamas, María | pt_PT |
dc.contributor.author | López-Durán, Ana | pt_PT |
dc.contributor.author | Sánchez, Coro | pt_PT |
dc.contributor.author | Herdeiro, Maria Teresa | pt_PT |
dc.contributor.author | Zapata-Cachafeiro, Maruxa | pt_PT |
dc.date.accessioned | 2021-03-31T12:23:24Z | - |
dc.date.available | 2021-03-31T12:23:24Z | - |
dc.date.issued | 2020 | - |
dc.identifier.issn | 2047-2994 | pt_PT |
dc.identifier.uri | http://hdl.handle.net/10773/31077 | - |
dc.description.abstract | Objectives: This 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. Design: Large-sized, two-arm, open-label, pragmatic, cluster-randomised controlled trial. Setting: All primary care physicians working for the Spanish National Health Service (NHS) in Galicia (region in north-west Spain). Participants: The 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. Interventions: One-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 measures: Changes 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. Results: Median 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. Conclusions: Interventions designed on the basis of gaps in physicians’ knowledge of and attitudes to misprescription can improve antibiotic prescribing and yield important direct cost savings. Trial registration: Current Controlled Trials ISRCTN24158380. Registered 5 February 2009. © 2020, The Author(s). | pt_PT |
dc.description.sponsorship | 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. | pt_PT |
dc.language.iso | eng | pt_PT |
dc.publisher | BMC | pt_PT |
dc.rights | openAccess | pt_PT |
dc.rights.uri | https://creativecommons.org/licenses/by/4.0/ | pt_PT |
dc.subject | Antibiotics | pt_PT |
dc.subject | Attitudes | pt_PT |
dc.subject | Educational intervention | pt_PT |
dc.subject | Inappropriate prescribing | pt_PT |
dc.subject | Microbial resistances | pt_PT |
dc.subject | Physicians | pt_PT |
dc.subject | Primary care | pt_PT |
dc.title | Impact of a multifaceted intervention to improve antibiotic prescribing: a pragmatic cluster-randomised controlled trial | pt_PT |
dc.type | article | pt_PT |
dc.description.version | published | pt_PT |
dc.peerreviewed | yes | pt_PT |
degois.publication.firstPage | 1 | pt_PT |
degois.publication.issue | 1 | pt_PT |
degois.publication.lastPage | 12 | pt_PT |
degois.publication.title | Antimicrobial Resistance and Infection Control | pt_PT |
degois.publication.volume | 9 | pt_PT |
dc.identifier.doi | 10.1186/s13756-020-00857-9 | pt_PT |
dc.identifier.essn | 2047-2994 | pt_PT |
Appears in Collections: | IBIMED - Artigos DCM - Artigos |
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artigo.pdf | 1.44 MB | Adobe PDF | View/Open |
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