Study ID | Study design | Country | Participants | Setting | Intervention details | Target illness | Duration |
---|---|---|---|---|---|---|---|
Educational interventions | |||||||
Llor et al. 2014 [13] | before-after quality assurance study | Spain | General practitioners (GPs) registered all patients with RTIs for 15 days in winter 2008 | Primary Care centres in Spain | Meetings with the presentation and discussion of the results, and several training meetings on RTI guidelines, workshops on point-of-care tests -rapid antigen detection tests and C-reactive protein rapid test. | RTIs | 1 year |
Wei et al. 2017 [14] | cluster-RCT | China | Participants attended a township hospital as an outpatient, were aged between 2 and 14 years old, and were given a prescription of upper respiratory tract infection | 25 township hospitals within the rural, low-income province of Guangxi in western China | Clinical guidelines; monthly peer-review meetings, integrated within routine monthly administrative meetings, during which doctors’ antibiotic prescribing rates were assessed; we developed leaflets and a video educating caregivers about antibiotics. | Upper respiratory tract infections | 6 months |
Hernandez Santiago et al. 2015 [15] | interrupted time series | United Kingdom | 408058 residents of the Tayside region of Scotland | Local general practices clinics | Practices received a range of educational material, specific feedback on their own use of antimicrobials; the local Antimicrobial Management Team gave specific advice to general practices | not specified | 5 years |
Lemiengre et al. 2018 [16] | cluster-RCT | Belgium | 169 FPs started recruitment and 3288 acute infectious episodes | Clinician practices | (1) a point-of-care C-reactive protein test (POC CRP); (2) a brief intervention to elicit parental concern combined with safety net advice (BISNA); (3) both POC CRP and BISNA; | ARTIs (acute respiratory tract infections) | 1 year |
Hürlimann et al. 2014 [17] | cluster-RCT | Switzerland | 16863 cases with RTIs and 4245 cases with lower UTIs per year | 140 primary care physicians in Switzerland | Printed guidelines for antibiotic prescription in RTIs and UTIs; individual feedback on antibiotic prescribing behaviour | RTIs and UTIs | 16 months |
Audit and feedback interventions | |||||||
Altiner et al. 2007 [18] | cluster-RCT | Germany | 104 GPs in North-Rhine and Westphalia-Lippe | Regional GPs clinics | GPs in the intervention group were visited by GP peers in their clinics | RTIs | 6 weeks/1 year |
Gerber et al. 2013 [19] | cluster-RCT | USA | 162 clinicians participated. | A network of 25 pediatric primary care practices | One 1-hour on-site clinician education session (June 2010) followed by 1 year of personalized, quarterly audit and feedback of prescribing for bacterial and viral ARTIs or usual practice. | ARTIs (acute respiratory tract infections) | 1 year |
Welschen et al. 2004 [20] | RCT | Netherlands | patients presenting with acute symptoms of the respiratory tract | Peer review groups (general practitioners) in the region of Utrecht | Group education meetings; monitoring and feedback on prescribing behavior; group education for assistants of general practitioners and pharmacists; Education materials for patients | acute symptoms of the respiratory tract | 1 year |
van der Velden et al. 2016 [21] | cluster-RCT | Netherlands | 169 general practitioners | 88 primary care practices participating | GP education, audit/feedback and patient information | ARTI | 10–12 months |
Health policy change strategies | |||||||
Yang 2014 [22] | A matched-pair cluster-randomized trial | China | public residents in 20 participating primary care organisations | QJ city of Hubei province, involving 20 primary care organisations | Public reporting on antibiotic prescribing for URTIs | upper respiratory tract infections | 1 year |
Yip et al. 2014 [23] | A matched-pair cluster-randomized trial | China | twenty-eight towns centers and posts | Twenty-eight towns in Ningxia province | This study’s policy intervention changed NCMS payments to township health centers and village posts from fee-for-service to a capitated budget with pay-for-performance. | not specified | 3 years |
Xiaoxia 2017 [24] | control before and after | China | Heads of different departments of primary health centers | 17 primary health centers in Jiande, China | Prescribing check results as an important indicator of professional promotion and bonus performance; feedback and audit on primary center doctors prescribing. | not specified | 3 months |
Information system supported interventions | |||||||
Gulliford et al. 2014 [25] | cluster-RCT | United Kingdom | Individual patients included all those aged 18 to 59 years who were registered with the trial practices. | 445 family practices | The decision support tools were installed remotely at the intervention arm practices and delivered during consultations | Urinary Tract Infections | 1 year |
Vellinga et al. 2016 [26] | cluster-RCT | Ireland | A total of 920 patients with suspected urinary tract infection | 30 eligible practices in Irish Primary Care | All practices received a workshop to promote consultation coding for urinary tract infections; a reminder integrated into the patient management software suggested first-line treatment; | urinary tract infection | 14 months |
Mainous et al. 2013 [27] | quasi-experimental trial | USA | 27 physicians, six nurse practitioners and six physician’s assistants volunteered to participate in this study. | Nine intervention practices and 61 control practices | Quarterly EHR based audit and feedback, ‘best-practice’ dissemination during meetings of practice representatives and practice site visits for academic detailing, performance review, and CDSS training. | ARTIs | 15 months |
Blair 2017 [28] | cluster-RCT | England | 542 Children (aged 3 months to <12 years) with acute cough and respiratory tract infection (RTI) | 32 general practices’ clinics | A web-based clinician-focused clinical rule to predict risk of future hospitalisation and a printed leaflet with individualised child health information for carers, safety-netting advice and a treatment decision record. | RTIs | 1 year |
Meeker et al. 2016 [29] | RCT | USA | 248 enrolled clinicians | 47 primary care practices | suggested alternatives presented electronic order sets; accountable justification prompted clinicians to enter free-text justifications for prescribing antibiotics; peer comparison | ARTIs | 18 months |