JMIR Publications

ABSTRACT

Background:

While numerous antimicrobial stewardship programs aim to decrease inappropriate antibiotic prescriptions, evidence of their positive impact is crucial.

Objective:

To evaluate multifaceted antibiotic stewardship interventions for inappropriate systemic antibiotic prescription in primary care.

Methods:

A cluster-randomized, open-label, controlled trial of 2501 general practitioners (GPs) in western France was conducted from July 2019 to January 2021. Two interventions were studied: the standard intervention (health insurance representative visit with prescription feedback and delivery of a treatment leaflet for cystitis and tonsillitis) and the second intervention (Clinical Decision Support System [CDSS]-based visit with prescription feedback and CDSS demonstration on antibiotic prescribing). The control group received no intervention. Data on systemic antibiotic dispensing were obtained from the Health National Insurance System (Système National d'Information Inter-Régimes de l'Assurance Maladie, SNIIRAM) database. The overall antibiotic volume dispensed per GP at 12 months was compared between arms using ANCOVA adjusted for annual antibiotic prescription volume at baseline.

Results:

Overall, 2501 GPs were randomized (mean age 53.4 years; 1099 women [43.9%]). At 12 months, the mean volume of systemic antibiotics per GP decreased by 209.1 DDD (95% CI -319.8 to -98.3, p<0.001) in the CDSS-based visit group compared with the control group. The decrease in the mean volume of systematic antibiotics dispensed per GP was not significantly different between the standard visit group and the control group (114.8 DDD; 95% CI -231.8 to 2.1; p=0.056).

Conclusions:

A health insurance visit combining feedback and a CDSS demonstration resulted in a 4.2% reduction in the total volume of systematic antibiotic prescriptions at 12 months. Clinical Trial: ClinicalTrials.gov Identifier: NCT04028830.