Table 1 Basic characteristics of included studies (n=17)

 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

 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

 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

 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