JMIR Publications

ABSTRACT

Background Growing microbial resistance is a major challenge of all health care systems around the world. In primary care, acute respiratory tract infection (ARTI) is the health condition most strongly related to antibiotic overuse. The RESIST program aims at optimizing antibiotic prescribing for ARTI in German primary care. By completing a problem-orientated online training course physicians are motivated and empowered to utilize patient-centered doctor-patient communication strategies including shared decision making in the treatment of patients with ARTI. Method RESIST is evaluated in form of a non-randomized controlled trial. Within the program about 3,000 physicians of eight (out of sixteen) German federal states can participate. Patient and physician data is retrieved from routine health care data. Physicians not participating in the program serve as control, either among the eight participating regional Associations of Statutory Health Insurance Physicians (control group 1), or among the remaining Associations not participating in RESIST (control group 2). Antibiotic prescription rates before intervention (T0: 2016, 1st and 2nd quarter 2017) and after intervention (T1: 3rd quarter 2017 until 1st quarter 2019) are compared. Primary outcome measure is the overall antibiotic prescription rate over all patients insured with German statutory health insurance before and after the provision of the online course. Secondary outcome is the antibiotic prescription rate for coded ARTI before and after the intervention. Discussion With about 3,000 physicians participating in the program, RESIST is among the largest real-world interventions aiming at reducing inadequate antibiotic prescribing for ARTI in primary care. Long-term follow-up of up to 21 months will allow investigating sustainability of the intervention.