|- candidate number||9109|
|- NTR Number||NTR2753|
|- ISRCTN||ISRCTN wordt niet meer aangevraagd.|
|- Date ISRCTN created|
|- date ISRCTN requested|
|- Date Registered NTR||14-feb-2011|
|- Secondary IDs||50-51700-98-013 ZonMw|
|- Public Title||Reducing antibiotic usage for acute respiratory infections by increasing guideline adherence including a wait-and-see prescription.|
|- Scientific Title||Reduce antibiotics use by wait-and-see prescription.|
|- hypothesis||Rationale: Antibiotic resistance is a growing problem worldwide with considerable costs. It is mainly driven by inappropriate use. It is necessary to look for measures that improve prescribing in antibiotics and that stimulate both health professionals and patients to consider their role in antibiotic use. One method to do so is the so-called wait-and-see prescription (WASP) or delayed prescription. In other countries, such postponed prescription has shown to be an effective means of reducing antibiotic usage for acute respiratory infections, allowing adequate control of symptoms while providing high levels of patient satisfaction.|
Objective: To reduce the (irrational) use of antibiotics in upper respiratory tract infections (URTI) in primary care by increasing guideline adherence and thus the use of wait-and-see prescriptions (WASP).
|- Healt Condition(s) or Problem(s) studied||Upper respiratory tract infection|
|- Inclusion criteria||1. All patients who consult their GP with URTI are in principal eligible to receive a wait-and-see prescription. Since, preferably, GPs should not prescribe antibiotics to patients with URTI, in practice only those patients for whom the GP thinks a WASP is an option will receive a WASP and only after discussing it with the patient (note: if the GP thinks the patient needs an antibiotic s/he will prescribe that antibiotic without discussing the principle of WASP). It is up to the GP to discuss a WASP with the patient and to decide whether or not to prescribe a WASP;|
2. Patients of all ages will be included.
|- Exclusion criteria||N/A|
|- mec approval received||yes|
|- multicenter trial||no|
|- Type||2 or more arms, randomized|
|- planned startdate ||1-mrt-2011|
|- planned closingdate||1-jul-2013|
|- Target number of participants||1600|
|- Interventions||Guideline adherence including prescribing wait-and-see prescriptions (WASP) will be subject of a training in 10 pharmacotherapy audit meetings (PTAMs). These 10 PTAMs (and consequently their participants) will be randomly assigned to intervention and control group. |
GPs and pharmacists in the intervention-PTAMs will be trained in their PTAM on the principles of WASP and on how to implement this in clinical practice. Special attention will be paid to communication strategies with patients. PTAMs make agreements on how and when to propose a WASP to patients. These agreements are electronically stored and GPs are electronically reminded to these WASP-agreements when they want to prescribe an antibiotic for URTI.
|- Primary outcome||The primary outcome measure is the number of patients with URTI who filled their antibiotic prescription at the pharmacy in the 12 months before the first PTAM-meeting (pretest) and 12 months hereafter (posttest).|
|- Secondary outcome||1. Cccurence of complications (e.g. bronchitis and pneumonia);|
2. Patients' judgement on the quality of care received for URTI.
|- Timepoints||Pretest (t0): Number of antibiotic prescriptions filled at the pharmacy in the 12 months before the first PTAM-meeting;|
Posttest (t1): Number of antibiotic prescriptions filled at the pharmacy in the 12 months after the first PTAM-meeting.
|- Trial web site||N/A|
|- CONTACT FOR PUBLIC QUERIES||PhD. Marianne Meulepas|
|- CONTACT for SCIENTIFIC QUERIES||PhD. Liset Dijk, van|
|- Sponsor/Initiator ||IVM, Dutch Institute for Rational Use of Medicine|
(Source(s) of Monetary or Material Support)
|ZON-MW, The Netherlands Organization for Health Research and Development|
|- Brief summary||N/A|
|- Main changes (audit trail)|
|- RECORD||14-feb-2011 - 21-feb-2011|