Implementation of Academic Detailing Interventions on Prescribing of Antimicrobial Drugs in Primary Health Care

NCT05090475 | Completed

• 1 other identifier: hospital A-team_primary care
• Study Type: interventional
• Target: 16
• Locations: 1 country
• Sites: 1

Brief Summary

World increase in mortality from consequences of antimicrobial resistance (AMR) represents a significant public health problem. Irrational prescribing of antimicrobial drugs (AMD) in general population is one of the main causes of development AMR. This is also contributed by fact that up to 90% of total antimicrobial consumption in Europe is related to the general population. Problem of AMR has been recognized by World Health Organization and Council of European Union, which support the establishment of the antimicrobial stewardship team (A-team). A-team provides co-ordinated interventions that promote rational use of AMD. To date, no study has been carried out in which A-team from hospital environment goes to primary health care for the purpose of rationalization prescribing of AMD by primary health care practitioners. Project for implementation of hospital A-team in primary health care in Koprivnica-Križevci County was initiated using academic detailing method aimed at rationalization of the consumption of AMD.

Conditions

Upper Respiratory Tract Infections; Acute Respiratory Tract Infection; Viral Infection

Keywords

Antimicrobial resistance; Hospital A-team; Academic detailing intervention; Antimicrobial prescribing; Primary care

Outcome Measures

Primary Outcomes (1)

• Proportion of antimicrobials expressed as DDD per day for ATC group J01 associated with acute respiratory tract infections

  Rationalization of consumption of antimicrobials for acute respiratory tract infections (for associated ICD diagnoses J01, J02, J03, J06, J20)

  1 year

Secondary Outcomes (1)

• Change in Clostridiodes dificile infection for patients on antimicrobial therapy

  1 year

Study Arms (3)

Experimental group in Koprivnica Križevci County

EXPERIMENTAL

Hospital A-team provided academic detailing intervention to primary care physicians in Koprivnica Križevci county who agree to participate

Behavioral: Academic detailing intervention

Control group in Koprivnica Križevci county

NO INTERVENTION

Primary care physicians in Koprivnica Križevci county who did not agree to participate in academic detailing intervention

Control group in Bjelovar Bilogora county

NO INTERVENTION

Primary care physicians in Bjelovar Bilogora county without the academic detailing intervention

Interventions

Academic detailing intervention BEHAVIORAL

Academic detailing or educational outreach is a method based on scientific data with the help of educated A-team members in the form of direct (face-to-face) interactions, prescribing practices change and adherence improves according to the application of currently valid therapeutic guidelines

Experimental group in Koprivnica Križevci County

Eligibility Criteria

• Age: 25 Years - 75 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• All primary care physicians in Koprivnica Križevci County that agree to participate in the study

You may not qualify if:

• Primary care physicians outside Koprivnica Križevci County

Sponsors & Collaborators

• General Hospital Koprivnica: lead
• Koprivnica Križevci County: collaborator
• Interdisciplinary section for the control of antibiotic resistance (ISKRA): collaborator

Study Sites (1)

Koprivnica križevci county

Koprivnica, Koprivnica-Križevci County, 48000, Croatia

Location

Related Publications (12)

• Bryce A, Hay AD, Lane IF, Thornton HV, Wootton M, Costelloe C. Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: systematic review and meta-analysis. BMJ. 2016 Mar 15;352:i939. doi: 10.1136/bmj.i939.

  PMID: 26980184 BACKGROUND

• Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ. 2010 May 18;340:c2096. doi: 10.1136/bmj.c2096.

  PMID: 20483949 BACKGROUND

• Marquet K, Liesenborgs A, Bergs J, Vleugels A, Claes N. Incidence and outcome of inappropriate in-hospital empiric antibiotics for severe infection: a systematic review and meta-analysis. Crit Care. 2015 Feb 16;19(1):63. doi: 10.1186/s13054-015-0795-y.

  PMID: 25888181 BACKGROUND

• Teillant A, Gandra S, Barter D, Morgan DJ, Laxminarayan R. Potential burden of antibiotic resistance on surgery and cancer chemotherapy antibiotic prophylaxis in the USA: a literature review and modelling study. Lancet Infect Dis. 2015 Dec;15(12):1429-37. doi: 10.1016/S1473-3099(15)00270-4. Epub 2015 Oct 22.

  PMID: 26482597 BACKGROUND

• Bassetti M, Righi E. Development of novel antibacterial drugs to combat multiple resistant organisms. Langenbecks Arch Surg. 2015 Feb;400(2):153-65. doi: 10.1007/s00423-015-1280-4. Epub 2015 Feb 11.

  PMID: 25667169 BACKGROUND

• Gundlapalli AV, Beekmann SE, Graham DR, Polgreen PM; Members of the Emerging Infections Network. Antimicrobial Agent Shortages: The New Norm for Infectious Diseases Physicians. Open Forum Infect Dis. 2018 Apr 23;5(4):ofy068. doi: 10.1093/ofid/ofy068. eCollection 2018 Apr.

  PMID: 29732380 BACKGROUND

• Nellums LB, Thompson H, Holmes A, Castro-Sanchez E, Otter JA, Norredam M, Friedland JS, Hargreaves S. Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis. Lancet Infect Dis. 2018 Jul;18(7):796-811. doi: 10.1016/S1473-3099(18)30219-6. Epub 2018 May 17.

  PMID: 29779917 BACKGROUND

• Chitnis AS, Holzbauer SM, Belflower RM, Winston LG, Bamberg WM, Lyons C, Farley MM, Dumyati GK, Wilson LE, Beldavs ZG, Dunn JR, Gould LH, MacCannell DR, Gerding DN, McDonald LC, Lessa FC. Epidemiology of community-associated Clostridium difficile infection, 2009 through 2011. JAMA Intern Med. 2013 Jul 22;173(14):1359-67. doi: 10.1001/jamainternmed.2013.7056.

  PMID: 23780507 BACKGROUND

• Avorn J, Soumerai SB. Improving drug-therapy decisions through educational outreach. A randomized controlled trial of academically based "detailing". N Engl J Med. 1983 Jun 16;308(24):1457-63. doi: 10.1056/NEJM198306163082406.

  PMID: 6406886 BACKGROUND

• Soumerai SB, Avorn J. Principles of educational outreach ('academic detailing') to improve clinical decision making. JAMA. 1990 Jan 26;263(4):549-56.

  PMID: 2104640 BACKGROUND

• O'Brien MA, Rogers S, Jamtvedt G, Oxman AD, Odgaard-Jensen J, Kristoffersen DT, Forsetlund L, Bainbridge D, Freemantle N, Davis DA, Haynes RB, Harvey EL. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2007 Oct 17;2007(4):CD000409. doi: 10.1002/14651858.CD000409.pub2.

  PMID: 17943742 BACKGROUND

• Meeker D, Linder JA, Fox CR, Friedberg MW, Persell SD, Goldstein NJ, Knight TK, Hay JW, Doctor JN. Effect of Behavioral Interventions on Inappropriate Antibiotic Prescribing Among Primary Care Practices: A Randomized Clinical Trial. JAMA. 2016 Feb 9;315(6):562-70. doi: 10.1001/jama.2016.0275.

  PMID: 26864410 BACKGROUND

Related Links

• WHO Antimicrobial resistance
• Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations. The Review on Antimicrobial Resistance
• Prioritization of pathogens to guide discovery, research and development of new antibiotics for drug-resistant bacterial infections, including tuberculosis
• Antimicrobial consumption - Annual Epidemiological Report for 2017
• Global Action Plan on Antimicrobial Resistance.

MeSH Terms

Conditions

Respiratory Tract Infections; Virus Diseases

Condition Hierarchy (Ancestors)

Infections; Respiratory Tract Diseases

Study Officials

• Darija Kuruc Poje

  General Hospital Koprivnica

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Head of hospital pharmacy, Clinical pharmacist

Study Record Dates

• First Submitted: July 6, 2021
• First Posted: October 22, 2021
• Study Start: April 1, 2020
• Primary Completion: April 30, 2020
• Study Completion: December 31, 2022
• Last Updated: January 2, 2024

Record last verified: 2023-12

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, CSR

Locations

CR (1)