Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial
Summary Background High-volume prescribing of antibiotics in primary care is a major driver of antibiotic resistance. Education of physicians and patients can lower prescribing levels, but it frequently relies on highly trained staff. We assessed whether internet-based training methods could alter p...
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| Veröffentlicht in: | The Lancet (British edition) 2013-10, Vol.382 (9899), p.1175-1182 |
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| creator | Little, Paul, Prof Stuart, Beth, PhD Francis, Nick, PhD Douglas, Elaine, MSc Tonkin-Crine, Sarah, PhD Anthierens, Sibyl, PhD Cals, Jochen WL, PhD Melbye, Hasse, Prof Santer, Miriam, PhD Moore, Michael, FRCGP Coenen, Samuel, Prof Butler, Chris, Prof Hood, Kerenza, Prof Kelly, Mark, PhD Godycki-Cwirko, Maciek, PhD Mierzecki, Artur, PhD Torres, Antoni, Prof Llor, Carl, PhD Davies, Melanie, MSc Mullee, Mark, MSc O'Reilly, Gilly, PhD van der Velden, Alike, PhD Geraghty, Adam WA, PhD Goossens, Herman, Prof Verheij, Theo, Prof Yardley, Lucy, Prof |
| description | Summary Background High-volume prescribing of antibiotics in primary care is a major driver of antibiotic resistance. Education of physicians and patients can lower prescribing levels, but it frequently relies on highly trained staff. We assessed whether internet-based training methods could alter prescribing practices in multiple health-care systems. Methods After a baseline audit in October to December, 2010, primary-care practices in six European countries were cluster randomised to usual care, training in the use of a C-reactive protein (CRP) test at point of care, in enhanced communication skills, or in both CRP and enhanced communication. Patients were recruited from February to May, 2011. This trial is registered, number ISRCTN99871214. Results The baseline audit, done in 259 practices, provided data for 6771 patients with lower-respiratory-tract infections (3742 [55·3%]) and upper-respiratory-tract infections (1416 [20·9%]), of whom 5355 (79·1%) were prescribed antibiotics. After randomisation, 246 practices were included and 4264 patients were recruited. The antibiotic prescribing rate was lower with CRP training than without (33% vs 48%, adjusted risk ratio 0·54, 95% CI 0·42–0·69) and with enhanced-communication training than without (36% vs 45%, 0·69, 0·54–0·87). The combined intervention was associated with the greatest reduction in prescribing rate (CRP risk ratio 0·53, 95% CI 0·36–0·74, p |
| doi_str_mv | 10.1016/S0140-6736(13)60994-0 |
| format | Article |
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Education of physicians and patients can lower prescribing levels, but it frequently relies on highly trained staff. We assessed whether internet-based training methods could alter prescribing practices in multiple health-care systems. Methods After a baseline audit in October to December, 2010, primary-care practices in six European countries were cluster randomised to usual care, training in the use of a C-reactive protein (CRP) test at point of care, in enhanced communication skills, or in both CRP and enhanced communication. Patients were recruited from February to May, 2011. This trial is registered, number ISRCTN99871214. Results The baseline audit, done in 259 practices, provided data for 6771 patients with lower-respiratory-tract infections (3742 [55·3%]) and upper-respiratory-tract infections (1416 [20·9%]), of whom 5355 (79·1%) were prescribed antibiotics. After randomisation, 246 practices were included and 4264 patients were recruited. The antibiotic prescribing rate was lower with CRP training than without (33% vs 48%, adjusted risk ratio 0·54, 95% CI 0·42–0·69) and with enhanced-communication training than without (36% vs 45%, 0·69, 0·54–0·87). The combined intervention was associated with the greatest reduction in prescribing rate (CRP risk ratio 0·53, 95% CI 0·36–0·74, p<0·0001; enhanced communication 0·68, 0·50–0·89, p=0·003; combined 0·38, 0·25–0·55, p<0·0001). Interpretation Internet training achieved important reductions in antibiotic prescribing for respiratory-tract infections across language and cultural boundaries. Funding European Commission Framework Programme 6, National Institute for Health Research, Research Foundation Flanders.</description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(13)60994-0</identifier><identifier>PMID: 23915885</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>Kidlington: Elsevier Ltd</publisher><subject>Acute Disease ; Anti-Bacterial Agents - therapeutic use ; Antibacterial agents ; Antibiotic resistance ; Antibiotics ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Biological and medical sciences ; C-reactive protein ; C-Reactive Protein - metabolism ; Chronic obstructive pulmonary disease ; Clinical Competence - standards ; Cluster Analysis ; Communication ; communication skills ; Drug therapy ; Ear diseases ; education ; Ethics ; Europe ; Family physicians ; Female ; General aspects ; General Practice - education ; General Practice - standards ; Humans ; Infections ; Inservice Training ; Internal Medicine ; Internet ; Male ; Medical sciences ; Middle Aged ; Online instruction ; patients ; Pharmacology. Drug treatments ; physicians ; Point-of-Care Systems ; Practice Patterns, Physicians' - standards ; Primary care ; Primary Health Care - standards ; Proteins ; relative risk ; Respiratory Tract Infections - drug therapy ; Teaching - methods ; Training</subject><ispartof>The Lancet (British edition), 2013-10, Vol.382 (9899), p.1175-1182</ispartof><rights>Elsevier Ltd</rights><rights>2013 Elsevier Ltd</rights><rights>2014 INIST-CNRS</rights><rights>Copyright © 2013 Elsevier Ltd. All rights reserved.</rights><rights>Copyright Elsevier Limited Oct 5, 2013</rights><rights>2013 Elsevier Ltd. All rights reserved. 2013 Elsevier Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c755t-f77328699e813cc12812e8f7c826731e5b1d687cf1c440754edb47cca017674f3</citedby><cites>FETCH-LOGICAL-c755t-f77328699e813cc12812e8f7c826731e5b1d687cf1c440754edb47cca017674f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0140673613609940$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27757445$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23915885$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Little, Paul, Prof</creatorcontrib><creatorcontrib>Stuart, Beth, PhD</creatorcontrib><creatorcontrib>Francis, Nick, PhD</creatorcontrib><creatorcontrib>Douglas, Elaine, MSc</creatorcontrib><creatorcontrib>Tonkin-Crine, Sarah, PhD</creatorcontrib><creatorcontrib>Anthierens, Sibyl, PhD</creatorcontrib><creatorcontrib>Cals, Jochen WL, PhD</creatorcontrib><creatorcontrib>Melbye, Hasse, Prof</creatorcontrib><creatorcontrib>Santer, Miriam, PhD</creatorcontrib><creatorcontrib>Moore, Michael, FRCGP</creatorcontrib><creatorcontrib>Coenen, Samuel, Prof</creatorcontrib><creatorcontrib>Butler, Chris, Prof</creatorcontrib><creatorcontrib>Hood, Kerenza, Prof</creatorcontrib><creatorcontrib>Kelly, Mark, PhD</creatorcontrib><creatorcontrib>Godycki-Cwirko, Maciek, PhD</creatorcontrib><creatorcontrib>Mierzecki, Artur, PhD</creatorcontrib><creatorcontrib>Torres, Antoni, Prof</creatorcontrib><creatorcontrib>Llor, Carl, PhD</creatorcontrib><creatorcontrib>Davies, Melanie, MSc</creatorcontrib><creatorcontrib>Mullee, Mark, MSc</creatorcontrib><creatorcontrib>O'Reilly, Gilly, PhD</creatorcontrib><creatorcontrib>van der Velden, Alike, PhD</creatorcontrib><creatorcontrib>Geraghty, Adam WA, PhD</creatorcontrib><creatorcontrib>Goossens, Herman, Prof</creatorcontrib><creatorcontrib>Verheij, Theo, Prof</creatorcontrib><creatorcontrib>Yardley, Lucy, Prof</creatorcontrib><creatorcontrib>on behalf of the GRACE consortium</creatorcontrib><creatorcontrib>GRACE consortium</creatorcontrib><title>Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><description>Summary Background High-volume prescribing of antibiotics in primary care is a major driver of antibiotic resistance. Education of physicians and patients can lower prescribing levels, but it frequently relies on highly trained staff. We assessed whether internet-based training methods could alter prescribing practices in multiple health-care systems. Methods After a baseline audit in October to December, 2010, primary-care practices in six European countries were cluster randomised to usual care, training in the use of a C-reactive protein (CRP) test at point of care, in enhanced communication skills, or in both CRP and enhanced communication. Patients were recruited from February to May, 2011. This trial is registered, number ISRCTN99871214. Results The baseline audit, done in 259 practices, provided data for 6771 patients with lower-respiratory-tract infections (3742 [55·3%]) and upper-respiratory-tract infections (1416 [20·9%]), of whom 5355 (79·1%) were prescribed antibiotics. After randomisation, 246 practices were included and 4264 patients were recruited. The antibiotic prescribing rate was lower with CRP training than without (33% vs 48%, adjusted risk ratio 0·54, 95% CI 0·42–0·69) and with enhanced-communication training than without (36% vs 45%, 0·69, 0·54–0·87). The combined intervention was associated with the greatest reduction in prescribing rate (CRP risk ratio 0·53, 95% CI 0·36–0·74, p<0·0001; enhanced communication 0·68, 0·50–0·89, p=0·003; combined 0·38, 0·25–0·55, p<0·0001). Interpretation Internet training achieved important reductions in antibiotic prescribing for respiratory-tract infections across language and cultural boundaries. Funding European Commission Framework Programme 6, National Institute for Health Research, Research Foundation Flanders.</description><subject>Acute Disease</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibacterial agents</subject><subject>Antibiotic resistance</subject><subject>Antibiotics</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Biological and medical sciences</subject><subject>C-reactive protein</subject><subject>C-Reactive Protein - metabolism</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Clinical Competence - standards</subject><subject>Cluster Analysis</subject><subject>Communication</subject><subject>communication skills</subject><subject>Drug therapy</subject><subject>Ear diseases</subject><subject>education</subject><subject>Ethics</subject><subject>Europe</subject><subject>Family physicians</subject><subject>Female</subject><subject>General aspects</subject><subject>General Practice - education</subject><subject>General Practice - standards</subject><subject>Humans</subject><subject>Infections</subject><subject>Inservice Training</subject><subject>Internal Medicine</subject><subject>Internet</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Online instruction</subject><subject>patients</subject><subject>Pharmacology. Drug treatments</subject><subject>physicians</subject><subject>Point-of-Care Systems</subject><subject>Practice Patterns, Physicians' - standards</subject><subject>Primary care</subject><subject>Primary Health Care - standards</subject><subject>Proteins</subject><subject>relative risk</subject><subject>Respiratory Tract Infections - drug therapy</subject><subject>Teaching - methods</subject><subject>Training</subject><issn>0140-6736</issn><issn>1474-547X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BEC</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqNk91qFTEUhQdRbK0-ghoQoUJHk8nveFGRUn-g4EUteBdyMklNnZMck0zhvJMP6Z5zaqu9sTAwJPvbK3tW1jTNU4JfE0zEm1NMGG6FpGKf0FcC9z1r8b1mlzDJWs7kt_vN7jWy0zwq5QJjzATmD5udjvaEK8V3m1_H3jtbC0oehVhdjq62C1PcgGo2IYZ4jlJEJtawCKkGi1bZFZthBZVsqivIp4yMnapDUFoF2Ex53UK7raA5y4cUy1tk0HIaa4hmXpvxANlxKnDkAejEIS0DnHqAPLSlHDb1FGtO47gZBnYeNw-8GYt7cvXea84-HH89-tSefPn4-ej9SWsl57X1UtJOib53ilBrSadI55SXVnVgBnF8QQahpPXEMoYlZ25YMGmtwUQKyTzdaw63uqtpsXSDdTCGGfUqh6XJa51M0P9WYviuz9OlpgpLhRkI7F8J5PRzcqVq-DjrxtFEl6ai4ZJEJxjt-zugXPGuF0rdAWWqI_CIu6CU9oJQCeiLW-hFmjLcz0zRXipORAcU31I2p1Ky89duEKznQOpNIPWcNk2o3gRSY-h79reV111_EgjAyyvAFGtGD1GwodxwUnLJ2Mw933LeJG3OMzBnpx0mHGNCMeez6e-2hINoXAaXdbHBReuGkCGDekjhv8Me3lKwI_wCMNYPt3blxhddOo23IrMGoRsFTH8DDaodlQ</recordid><startdate>20131005</startdate><enddate>20131005</enddate><creator>Little, Paul, Prof</creator><creator>Stuart, Beth, PhD</creator><creator>Francis, Nick, PhD</creator><creator>Douglas, Elaine, MSc</creator><creator>Tonkin-Crine, Sarah, PhD</creator><creator>Anthierens, Sibyl, PhD</creator><creator>Cals, Jochen WL, PhD</creator><creator>Melbye, Hasse, Prof</creator><creator>Santer, Miriam, PhD</creator><creator>Moore, Michael, FRCGP</creator><creator>Coenen, Samuel, Prof</creator><creator>Butler, Chris, Prof</creator><creator>Hood, Kerenza, Prof</creator><creator>Kelly, Mark, PhD</creator><creator>Godycki-Cwirko, Maciek, PhD</creator><creator>Mierzecki, Artur, PhD</creator><creator>Torres, Antoni, Prof</creator><creator>Llor, Carl, PhD</creator><creator>Davies, Melanie, MSc</creator><creator>Mullee, Mark, MSc</creator><creator>O'Reilly, Gilly, PhD</creator><creator>van der Velden, Alike, PhD</creator><creator>Geraghty, Adam WA, PhD</creator><creator>Goossens, Herman, Prof</creator><creator>Verheij, Theo, Prof</creator><creator>Yardley, Lucy, Prof</creator><general>Elsevier Ltd</general><general>Elsevier</general><general>Elsevier Limited</general><general>Lancet Publishing Group</general><scope>6I.</scope><scope>AAFTH</scope><scope>FBQ</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0TT</scope><scope>0TZ</scope><scope>0U~</scope><scope>3V.</scope><scope>7QL</scope><scope>7QP</scope><scope>7RV</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88A</scope><scope>88C</scope><scope>88E</scope><scope>88G</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8C1</scope><scope>8C2</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>KB~</scope><scope>LK8</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2P</scope><scope>M7N</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope><scope>7U1</scope><scope>7U2</scope><scope>5PM</scope></search><sort><creationdate>20131005</creationdate><title>Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial</title><author>Little, Paul, Prof ; Stuart, Beth, PhD ; Francis, Nick, PhD ; Douglas, Elaine, MSc ; Tonkin-Crine, Sarah, PhD ; Anthierens, Sibyl, PhD ; Cals, Jochen WL, PhD ; Melbye, Hasse, Prof ; Santer, Miriam, PhD ; Moore, Michael, FRCGP ; Coenen, Samuel, Prof ; Butler, Chris, Prof ; Hood, Kerenza, Prof ; Kelly, Mark, PhD ; Godycki-Cwirko, Maciek, PhD ; Mierzecki, Artur, PhD ; Torres, Antoni, Prof ; Llor, Carl, PhD ; Davies, Melanie, MSc ; Mullee, Mark, MSc ; O'Reilly, Gilly, PhD ; van der Velden, Alike, PhD ; Geraghty, Adam WA, PhD ; Goossens, Herman, Prof ; Verheij, Theo, Prof ; Yardley, Lucy, Prof</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c755t-f77328699e813cc12812e8f7c826731e5b1d687cf1c440754edb47cca017674f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Acute Disease</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibacterial agents</topic><topic>Antibiotic resistance</topic><topic>Antibiotics</topic><topic>Antibiotics. 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(Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Lancet (British edition)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Little, Paul, Prof</au><au>Stuart, Beth, PhD</au><au>Francis, Nick, PhD</au><au>Douglas, Elaine, MSc</au><au>Tonkin-Crine, Sarah, PhD</au><au>Anthierens, Sibyl, PhD</au><au>Cals, Jochen WL, PhD</au><au>Melbye, Hasse, Prof</au><au>Santer, Miriam, PhD</au><au>Moore, Michael, FRCGP</au><au>Coenen, Samuel, Prof</au><au>Butler, Chris, Prof</au><au>Hood, Kerenza, Prof</au><au>Kelly, Mark, PhD</au><au>Godycki-Cwirko, Maciek, PhD</au><au>Mierzecki, Artur, PhD</au><au>Torres, Antoni, Prof</au><au>Llor, Carl, PhD</au><au>Davies, Melanie, MSc</au><au>Mullee, Mark, MSc</au><au>O'Reilly, Gilly, PhD</au><au>van der Velden, Alike, PhD</au><au>Geraghty, Adam WA, PhD</au><au>Goossens, Herman, Prof</au><au>Verheij, Theo, Prof</au><au>Yardley, Lucy, Prof</au><aucorp>on behalf of the GRACE consortium</aucorp><aucorp>GRACE consortium</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial</atitle><jtitle>The Lancet (British edition)</jtitle><addtitle>Lancet</addtitle><date>2013-10-05</date><risdate>2013</risdate><volume>382</volume><issue>9899</issue><spage>1175</spage><epage>1182</epage><pages>1175-1182</pages><issn>0140-6736</issn><eissn>1474-547X</eissn><coden>LANCAO</coden><abstract>Summary Background High-volume prescribing of antibiotics in primary care is a major driver of antibiotic resistance. Education of physicians and patients can lower prescribing levels, but it frequently relies on highly trained staff. We assessed whether internet-based training methods could alter prescribing practices in multiple health-care systems. Methods After a baseline audit in October to December, 2010, primary-care practices in six European countries were cluster randomised to usual care, training in the use of a C-reactive protein (CRP) test at point of care, in enhanced communication skills, or in both CRP and enhanced communication. Patients were recruited from February to May, 2011. This trial is registered, number ISRCTN99871214. Results The baseline audit, done in 259 practices, provided data for 6771 patients with lower-respiratory-tract infections (3742 [55·3%]) and upper-respiratory-tract infections (1416 [20·9%]), of whom 5355 (79·1%) were prescribed antibiotics. After randomisation, 246 practices were included and 4264 patients were recruited. The antibiotic prescribing rate was lower with CRP training than without (33% vs 48%, adjusted risk ratio 0·54, 95% CI 0·42–0·69) and with enhanced-communication training than without (36% vs 45%, 0·69, 0·54–0·87). The combined intervention was associated with the greatest reduction in prescribing rate (CRP risk ratio 0·53, 95% CI 0·36–0·74, p<0·0001; enhanced communication 0·68, 0·50–0·89, p=0·003; combined 0·38, 0·25–0·55, p<0·0001). Interpretation Internet training achieved important reductions in antibiotic prescribing for respiratory-tract infections across language and cultural boundaries. Funding European Commission Framework Programme 6, National Institute for Health Research, Research Foundation Flanders.</abstract><cop>Kidlington</cop><pub>Elsevier Ltd</pub><pmid>23915885</pmid><doi>10.1016/S0140-6736(13)60994-0</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0140-6736 |
| ispartof | The Lancet (British edition), 2013-10, Vol.382 (9899), p.1175-1182 |
| issn | 0140-6736 1474-547X |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3807804 |
| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Acute Disease Anti-Bacterial Agents - therapeutic use Antibacterial agents Antibiotic resistance Antibiotics Antibiotics. Antiinfectious agents. Antiparasitic agents Biological and medical sciences C-reactive protein C-Reactive Protein - metabolism Chronic obstructive pulmonary disease Clinical Competence - standards Cluster Analysis Communication communication skills Drug therapy Ear diseases education Ethics Europe Family physicians Female General aspects General Practice - education General Practice - standards Humans Infections Inservice Training Internal Medicine Internet Male Medical sciences Middle Aged Online instruction patients Pharmacology. Drug treatments physicians Point-of-Care Systems Practice Patterns, Physicians' - standards Primary care Primary Health Care - standards Proteins relative risk Respiratory Tract Infections - drug therapy Teaching - methods Training |
| title | Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-07T16%3A32%3A38IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Effects%20of%20internet-based%20training%20on%20antibiotic%20prescribing%20rates%20for%20acute%20respiratory-tract%20infections:%20a%20multinational,%20cluster,%20randomised,%20factorial,%20controlled%20trial&rft.jtitle=The%20Lancet%20(British%20edition)&rft.au=Little,%20Paul,%20Prof&rft.aucorp=on%20behalf%20of%20the%20GRACE%20consortium&rft.date=2013-10-05&rft.volume=382&rft.issue=9899&rft.spage=1175&rft.epage=1182&rft.pages=1175-1182&rft.issn=0140-6736&rft.eissn=1474-547X&rft.coden=LANCAO&rft_id=info:doi/10.1016/S0140-6736(13)60994-0&rft_dat=%3Cproquest_pubme%3E3091211831%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1439785162&rft_id=info:pmid/23915885&rft_els_id=S0140673613609940&rfr_iscdi=true |