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Reducing inappropriate antibiotic prescribing for children in primary care : a cluster randomised controlled trial of two interventions

(2018) BRITISH JOURNAL OF GENERAL PRACTICE. 68(668). p.e204-e210
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Abstract
Background : Antibiotics are overprescribed for non-severe acute infections in children in primary care. Aim : To explore two different interventions that may reduce inappropriate antibiotic prescribing for non-severe acute infections. Design and setting : A cluster randomised, factorial controlled trial in primary care, in Flanders, Belgium. Method : Family physicians (FPs) enrolled children with non-severe acute infections into this study. The participants were allocated to one of four intervention groups according to whether the FPs performed: (1) a point-of-care C-reactive protein test (POC CRP); (2) a brief intervention to elicit parental concern combined with safety net advice (BISNA); (3) both POC CRP and BISNA; or (4) usual care (UC). Guidance on the interpretation of CRP was not provided. The main outcome was the immediate antibiotic prescribing rate. A mixed logistic regression was performed to analyse the data. Results : In this study 2227 non-severe acute infections in children were registered by 131 FPs. In comparison with UC, POC CRP did not influence antibiotic prescribing, (adjusted odds ratio [AOR] 1.01, 95% confidence interval [CI] = 0.57 to 1.79). BISNA increased antibiotic prescribing (AOR 2.04, 95% CI = 1.19 to 3.50). In combination with POC CRP, this increase disappeared. Conclusion : Systematic POC CRP testing without guidance is not an effective strategy to reduce antibiotic prescribing for non-severe acute infections in children in primary care. Eliciting parental concern and providing a safety net without POC CRP testing conversely increased antibiotic prescribing. FPs possibly need more training in handling parental concern without inappropriately prescribing antibiotics.
Keywords
children, cluster randomised controlled trial, inappropriate prescribing, physician patient communication, point-of-care testing: primary care, RESPIRATORY-TRACT INFECTIONS, ACUTELY ILL CHILDREN, C-REACTIVE PROTEIN, CRP, PRESCRIPTION

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Citation

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Chicago
Lemiengre, Marieke, Jan Y Verbakel, Roos Colman, Tine De Burghgraeve, Frank Buntinx, Bert Aertgeerts, Frans De Baets, and An De Sutter. 2018. “Reducing Inappropriate Antibiotic Prescribing for Children in Primary Care : a Cluster Randomised Controlled Trial of Two Interventions.” British Journal of General Practice 68 (668): e204–e210.
APA
Lemiengre, Marieke, Verbakel, J. Y., Colman, R., De Burghgraeve, T., Buntinx, F., Aertgeerts, B., De Baets, F., et al. (2018). Reducing inappropriate antibiotic prescribing for children in primary care : a cluster randomised controlled trial of two interventions. BRITISH JOURNAL OF GENERAL PRACTICE, 68(668), e204–e210.
Vancouver
1.
Lemiengre M, Verbakel JY, Colman R, De Burghgraeve T, Buntinx F, Aertgeerts B, et al. Reducing inappropriate antibiotic prescribing for children in primary care : a cluster randomised controlled trial of two interventions. BRITISH JOURNAL OF GENERAL PRACTICE. 2018;68(668):e204–e210.
MLA
Lemiengre, Marieke, Jan Y Verbakel, Roos Colman, et al. “Reducing Inappropriate Antibiotic Prescribing for Children in Primary Care : a Cluster Randomised Controlled Trial of Two Interventions.” BRITISH JOURNAL OF GENERAL PRACTICE 68.668 (2018): e204–e210. Print.
@article{8564303,
  abstract     = {Background : Antibiotics are overprescribed for non-severe acute infections in children in primary care. 
Aim : To explore two different interventions that may reduce inappropriate antibiotic prescribing for non-severe acute infections. 
Design and setting : A cluster randomised, factorial controlled trial in primary care, in Flanders, Belgium. 
Method : Family physicians (FPs) enrolled children with non-severe acute infections into this study. The participants were allocated to one of four intervention groups according to whether the FPs performed: (1) a point-of-care C-reactive protein test (POC CRP); (2) a brief intervention to elicit parental concern combined with safety net advice (BISNA); (3) both POC CRP and BISNA; or (4) usual care (UC). Guidance on the interpretation of CRP was not provided. The main outcome was the immediate antibiotic prescribing rate. A mixed logistic regression was performed to analyse the data. 
Results : In this study 2227 non-severe acute infections in children were registered by 131 FPs. In comparison with UC, POC CRP did not influence antibiotic prescribing, (adjusted odds ratio [AOR] 1.01, 95\% confidence interval [CI] = 0.57 to 1.79). BISNA increased antibiotic prescribing (AOR 2.04, 95\% CI = 1.19 to 3.50). In combination with POC CRP, this increase disappeared. 
Conclusion : Systematic POC CRP testing without guidance is not an effective strategy to reduce antibiotic prescribing for non-severe acute infections in children in primary care. Eliciting parental concern and providing a safety net without POC CRP testing conversely increased antibiotic prescribing. FPs possibly need more training in handling parental concern without inappropriately prescribing antibiotics.},
  author       = {Lemiengre, Marieke and Verbakel, Jan Y and Colman, Roos and De Burghgraeve, Tine and Buntinx, Frank and Aertgeerts, Bert and De Baets, Frans and De Sutter, An},
  issn         = {0960-1643},
  journal      = {BRITISH JOURNAL OF GENERAL PRACTICE},
  keyword      = {children,cluster randomised controlled trial,inappropriate prescribing,physician patient communication,point-of-care testing: primary care,RESPIRATORY-TRACT INFECTIONS,ACUTELY ILL CHILDREN,C-REACTIVE PROTEIN,CRP,PRESCRIPTION},
  language     = {eng},
  number       = {668},
  pages        = {e204--e210},
  title        = {Reducing inappropriate antibiotic prescribing for children in primary care : a cluster randomised controlled trial of two interventions},
  url          = {http://dx.doi.org/10.3399/bjgp18x695033},
  volume       = {68},
  year         = {2018},
}

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