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Promoting rational antibiotic therapy among high antibiotic prescribers in German primary care-study protocol of the ElektRA 4-arm cluster-randomized controlled trial

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Promoting rational antibiotic therapy among high antibiotic prescribers in German primary care-study protocol of the ElektRA 4-arm cluster-randomized controlled trial. / Löffler, Christin; Buuck, Theresa; Iwen, Julia; Schulz, Maike; Zapf, Antonia; Kropp, Peter; Wollny, Anja; Krause, Linda; Müller, Britta; Ozga, Ann-Katrin; Goldschmidt, Elisabeth; Altiner, Attila.

In: IMPLEMENT SCI, Vol. 17, No. 1, 69, 04.10.2022.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Löffler, C, Buuck, T, Iwen, J, Schulz, M, Zapf, A, Kropp, P, Wollny, A, Krause, L, Müller, B, Ozga, A-K, Goldschmidt, E & Altiner, A 2022, 'Promoting rational antibiotic therapy among high antibiotic prescribers in German primary care-study protocol of the ElektRA 4-arm cluster-randomized controlled trial', IMPLEMENT SCI, vol. 17, no. 1, 69. https://doi.org/10.1186/s13012-022-01241-4

APA

Löffler, C., Buuck, T., Iwen, J., Schulz, M., Zapf, A., Kropp, P., Wollny, A., Krause, L., Müller, B., Ozga, A-K., Goldschmidt, E., & Altiner, A. (2022). Promoting rational antibiotic therapy among high antibiotic prescribers in German primary care-study protocol of the ElektRA 4-arm cluster-randomized controlled trial. IMPLEMENT SCI, 17(1), [69]. https://doi.org/10.1186/s13012-022-01241-4

Vancouver

Löffler C, Buuck T, Iwen J, Schulz M, Zapf A, Kropp P et al. Promoting rational antibiotic therapy among high antibiotic prescribers in German primary care-study protocol of the ElektRA 4-arm cluster-randomized controlled trial. IMPLEMENT SCI. 2022 Oct 4;17(1). 69. https://doi.org/10.1186/s13012-022-01241-4

Bibtex

@article{4ec50354311a409e94d323b94899d0fe,
title = "Promoting rational antibiotic therapy among high antibiotic prescribers in German primary care-study protocol of the ElektRA 4-arm cluster-randomized controlled trial",
abstract = "BACKGROUND: The rational use of antibiotics is of great importance in health care. In primary care, acute respiratory infections are the most common cause of inappropriate antibiotic prescribing. Since existing studies aiming to optimize antibiotic use are usually based on the voluntary participation of physicians, general practitioners (GPs) with inappropriate prescribing behavior are underrepresented. For the first time in Germany, the ElektRA study will assess and compare the effects of three interventions on antibiotic prescribing rates for respiratory and urinary tract infections among high prescribers in primary care.METHOD: ElektRA is a 4-arm cluster-randomized controlled trial among German GPs in nine regional Associations of Statutory Health Insurance Physicians. On their behalf, the Central Research Institute of Ambulatory Health Care in Germany (Zi) analyses all outpatient claims and prescription data. Based on this database, high antibiotic prescribing GPs are identified and randomized into four groups: a control group (N=2000) and three intervention arms. We test social norm feedback on antibiotic prescribing (N=2000), social norm feedback plus online training on rational prescribing practice and communication strategies (N=2000), and social norm feedback plus online peer-moderated training on rational antibiotic prescribing, communication strategies, and sustainable behavior change (N=1250). The primary outcome is the overall rate of antibiotic prescriptions. Outcomes are measured before intervention (T0, October 2020-September 2022) and over a period of 15 months (T1, October 2022 to December 2023) after randomization.DISCUSSION: The aim of the study is to implement individualized, low-threshold interventions to reduce antibiotic prescribing among high prescribers in primary care. If successful, a change in behavior among otherwise difficult-to-reach high prescribers will directly improve patient care. The increase in quality of care will ideally be achieved both in terms of the quantity of antibiotics used as well as the kind of substances prescribed. Also, if effective strategies for high prescribers are identified through this study, they can be applied not only to the antibiotics addressed in this study, but also to other areas of prescription management.TRIAL REGISTRATION: Current Controlled Trials ISRCTN95468513.Keywords: Antibacterial agents; Antibiotic resistance; Continuing medical education; Physician-patient relation; Primary care; Respiratory tract infection; Shared decision-making; Urinary tract infections. ",
keywords = "Anti-Bacterial Agents/therapeutic use, Humans, Inappropriate Prescribing/prevention & control, Practice Patterns, Physicians', Primary Health Care, Randomized Controlled Trials as Topic, Respiratory Tract Infections/drug therapy",
author = "Christin L{\"o}ffler and Theresa Buuck and Julia Iwen and Maike Schulz and Antonia Zapf and Peter Kropp and Anja Wollny and Linda Krause and Britta M{\"u}ller and Ann-Katrin Ozga and Elisabeth Goldschmidt and Attila Altiner",
note = "{\textcopyright} 2022. The Author(s).",
year = "2022",
month = oct,
day = "4",
doi = "10.1186/s13012-022-01241-4",
language = "English",
volume = "17",
journal = "IMPLEMENT SCI",
issn = "1748-5908",
publisher = "BioMed Central Ltd.",
number = "1",

}

RIS

TY - JOUR

T1 - Promoting rational antibiotic therapy among high antibiotic prescribers in German primary care-study protocol of the ElektRA 4-arm cluster-randomized controlled trial

AU - Löffler, Christin

AU - Buuck, Theresa

AU - Iwen, Julia

AU - Schulz, Maike

AU - Zapf, Antonia

AU - Kropp, Peter

AU - Wollny, Anja

AU - Krause, Linda

AU - Müller, Britta

AU - Ozga, Ann-Katrin

AU - Goldschmidt, Elisabeth

AU - Altiner, Attila

N1 - © 2022. The Author(s).

PY - 2022/10/4

Y1 - 2022/10/4

N2 - BACKGROUND: The rational use of antibiotics is of great importance in health care. In primary care, acute respiratory infections are the most common cause of inappropriate antibiotic prescribing. Since existing studies aiming to optimize antibiotic use are usually based on the voluntary participation of physicians, general practitioners (GPs) with inappropriate prescribing behavior are underrepresented. For the first time in Germany, the ElektRA study will assess and compare the effects of three interventions on antibiotic prescribing rates for respiratory and urinary tract infections among high prescribers in primary care.METHOD: ElektRA is a 4-arm cluster-randomized controlled trial among German GPs in nine regional Associations of Statutory Health Insurance Physicians. On their behalf, the Central Research Institute of Ambulatory Health Care in Germany (Zi) analyses all outpatient claims and prescription data. Based on this database, high antibiotic prescribing GPs are identified and randomized into four groups: a control group (N=2000) and three intervention arms. We test social norm feedback on antibiotic prescribing (N=2000), social norm feedback plus online training on rational prescribing practice and communication strategies (N=2000), and social norm feedback plus online peer-moderated training on rational antibiotic prescribing, communication strategies, and sustainable behavior change (N=1250). The primary outcome is the overall rate of antibiotic prescriptions. Outcomes are measured before intervention (T0, October 2020-September 2022) and over a period of 15 months (T1, October 2022 to December 2023) after randomization.DISCUSSION: The aim of the study is to implement individualized, low-threshold interventions to reduce antibiotic prescribing among high prescribers in primary care. If successful, a change in behavior among otherwise difficult-to-reach high prescribers will directly improve patient care. The increase in quality of care will ideally be achieved both in terms of the quantity of antibiotics used as well as the kind of substances prescribed. Also, if effective strategies for high prescribers are identified through this study, they can be applied not only to the antibiotics addressed in this study, but also to other areas of prescription management.TRIAL REGISTRATION: Current Controlled Trials ISRCTN95468513.Keywords: Antibacterial agents; Antibiotic resistance; Continuing medical education; Physician-patient relation; Primary care; Respiratory tract infection; Shared decision-making; Urinary tract infections.

AB - BACKGROUND: The rational use of antibiotics is of great importance in health care. In primary care, acute respiratory infections are the most common cause of inappropriate antibiotic prescribing. Since existing studies aiming to optimize antibiotic use are usually based on the voluntary participation of physicians, general practitioners (GPs) with inappropriate prescribing behavior are underrepresented. For the first time in Germany, the ElektRA study will assess and compare the effects of three interventions on antibiotic prescribing rates for respiratory and urinary tract infections among high prescribers in primary care.METHOD: ElektRA is a 4-arm cluster-randomized controlled trial among German GPs in nine regional Associations of Statutory Health Insurance Physicians. On their behalf, the Central Research Institute of Ambulatory Health Care in Germany (Zi) analyses all outpatient claims and prescription data. Based on this database, high antibiotic prescribing GPs are identified and randomized into four groups: a control group (N=2000) and three intervention arms. We test social norm feedback on antibiotic prescribing (N=2000), social norm feedback plus online training on rational prescribing practice and communication strategies (N=2000), and social norm feedback plus online peer-moderated training on rational antibiotic prescribing, communication strategies, and sustainable behavior change (N=1250). The primary outcome is the overall rate of antibiotic prescriptions. Outcomes are measured before intervention (T0, October 2020-September 2022) and over a period of 15 months (T1, October 2022 to December 2023) after randomization.DISCUSSION: The aim of the study is to implement individualized, low-threshold interventions to reduce antibiotic prescribing among high prescribers in primary care. If successful, a change in behavior among otherwise difficult-to-reach high prescribers will directly improve patient care. The increase in quality of care will ideally be achieved both in terms of the quantity of antibiotics used as well as the kind of substances prescribed. Also, if effective strategies for high prescribers are identified through this study, they can be applied not only to the antibiotics addressed in this study, but also to other areas of prescription management.TRIAL REGISTRATION: Current Controlled Trials ISRCTN95468513.Keywords: Antibacterial agents; Antibiotic resistance; Continuing medical education; Physician-patient relation; Primary care; Respiratory tract infection; Shared decision-making; Urinary tract infections.

KW - Anti-Bacterial Agents/therapeutic use

KW - Humans

KW - Inappropriate Prescribing/prevention & control

KW - Practice Patterns, Physicians'

KW - Primary Health Care

KW - Randomized Controlled Trials as Topic

KW - Respiratory Tract Infections/drug therapy

U2 - 10.1186/s13012-022-01241-4

DO - 10.1186/s13012-022-01241-4

M3 - SCORING: Journal article

C2 - 36195897

VL - 17

JO - IMPLEMENT SCI

JF - IMPLEMENT SCI

SN - 1748-5908

IS - 1

M1 - 69

ER -