Optimizing Antibiotic Prescribing for Acute Respiratory Tract Infections in German Primary Care: Results of the Regional Intervention Study CHANGE-3 and the Nested cRCT
Gregor Feldmeier,
Christin Löffler,
Attila Altiner,
Anja Wollny,
Katharina Garbe,
Dorothea Kronsteiner,
Martina Köppen,
Joachim Szecsenyi,
Mirko Leyh,
Arwed Voss,
Martina Kamradt,
Regina Poß-Doering,
Michel Wensing,
Petra Kaufmann-Kolle
Affiliations
Gregor Feldmeier
Institute of General Practice, Rostock University Medical Center, 18055 Rostock, Germany
Christin Löffler
Institute of General Practice, Rostock University Medical Center, 18055 Rostock, Germany
Attila Altiner
Department of General Practice and Health Services Research, University Hospital Heidelberg, 69120 Heidelberg, Germany
Anja Wollny
Institute of General Practice, Rostock University Medical Center, 18055 Rostock, Germany
Katharina Garbe
Institute of General Practice, Rostock University Medical Center, 18055 Rostock, Germany
Dorothea Kronsteiner
Institute of Medical Biometry, University Hospital Heidelberg, 69117 Heidelberg, Germany
Martina Köppen
aQua-Institute for Applied Quality Improvement and Research in Health Care GmbH, 37073 Göttingen, Germany
Joachim Szecsenyi
aQua-Institute for Applied Quality Improvement and Research in Health Care GmbH, 37073 Göttingen, Germany
Mirko Leyh
Department of Communication Design and Media, University of Applied Sciences, Technology, Business and Design, 23966 Wismar, Germany
Arwed Voss
Department of Communication Design and Media, University of Applied Sciences, Technology, Business and Design, 23966 Wismar, Germany
Martina Kamradt
Department of General Practice and Health Services Research, University Hospital Heidelberg, 69120 Heidelberg, Germany
Regina Poß-Doering
Department of General Practice and Health Services Research, University Hospital Heidelberg, 69120 Heidelberg, Germany
Michel Wensing
Department of General Practice and Health Services Research, University Hospital Heidelberg, 69120 Heidelberg, Germany
Petra Kaufmann-Kolle
aQua-Institute for Applied Quality Improvement and Research in Health Care GmbH, 37073 Göttingen, Germany
Within primary care, acute respiratory tract infections (ARTIs) are the most common reason for prescribing antibiotics. The aim of the CHANGE-3 study was to investigate how antibiotic prescribing for non-complicated ARTIs can be reduced to a reasonable level. The trial was conducted as a prospective study consisting of a regional public awareness intervention in two regions of Germany and a nested cluster randomised controlled trial (cRCT) of a complex implementation strategy. The study involved 114 primary care practices and comprised an intervention period of six winter months for the nested cRCT and two times six winter months for the regional intervention. The primary outcome was the percentage of antibiotic prescribing for ARTIs between baseline and the two following winter seasons. The regression analysis confirmed a general trend toward the restrained use of antibiotics in German primary care. This trend was found in both groups of the cRCT without significant differences between groups. At the same time, antibiotic prescribing was higher in routine care (with the public campaign only) than in both groups of the cRCT. With regard to secondary outcomes, in the nested cRCT, the prescribing of quinolones was reduced, and the proportion of guideline-recommended antibiotics increased.
