Table 2.
Author (year) | Study design (a) | Program description | Baseline and follow-up | Analysis (e) | Results (f) | |||
---|---|---|---|---|---|---|---|---|
Disease (b) | Intervention type (c,d) | Baseline | Intervention period | Follow-up | ||||
Dollman, WB (2005) [20] | 1 | URTI | IG: 1, 2, 8 | 5 months | 5 months | ___ | 2 | T (+) |
CG: 0 | ||||||||
Hrisos, S (2008) [21] | 4 | URTI | IG1: 3 | ___ | 3 months | ___ | 3 | At/Bh (+) |
IG2: 3 | ||||||||
IG1 + 2: 3 | ||||||||
CG: 0 | ||||||||
Hennessy, TW (2002) [22] | 3 | RTI | IG: 8, 2 | 2 months | 12 months (6 each year of intervention) | 2 months | 2, 3 | T (+) |
CG: 0 | ||||||||
Rubin, MA (2005) [23] | 2 | URTI | IG: 1, 2, 8, 9 | 6 months | 6 months | ___ | 2, 3 | T (+) |
CG: 0 | Ga (+) | |||||||
Naughton, C (2009) [24] | 4 | RTI | IG1: 3, 4 | 12 months | ___ | 12 months | 2, 3 | T (+) (−)a |
IG2: 3 | Ga (+) (−)a | |||||||
Chazan, B (2007) [25] | 1 | Infectious disease | IG1: 1, 2 | 4 months | 4 months | ___ | 2, 3 | T (+) |
IG2: 1, 2, 8 | ||||||||
Briel, M (2005) [26] | 4 | ARTI | IG1: 1,2 | ___ | 5 months | ___ | 1 | T (+) |
IG2: 1,2 | ||||||||
CG: 0 | ||||||||
Monette, J (2007) [27] | 4 | Lower RTI | IG: 1, 3 | 3 months | 2 x 3 months | 3 months | 5, 6 | Ga (+) |
UTI | CG: 0 | |||||||
Skin and soft-tissue infections septicemia | ||||||||
Enriquez-Puga, A (2009) [28] | 4 | ___ | IG: 1, 3, 4 | 2 periods of 6 months | 6 months | 24 months | 5, 6 | Ga (−) |
Bjerrum, L (2006) [29] | 2 | RTI | IG: 2, 3, 10 | 3 weeks during 3 months | 3 weeks during 3 months | ___ | 1, 2 | T (+) |
CG: 0 | Ga (+) | |||||||
Mcisaac, WJ (2002) [30] | 4 | Sore throat | IG: 1, 5 | ___ | ___ | ___ | 1 | T (−) |
CG: 0 | Ga (−) | |||||||
Wheeler, JG (2001) [31] | 1 | Viral infections | IG: 2, 8, 9 | 1 week | 3 weeks during 3 years | 6 months (qualitative) | 3 | T (−) |
At/Bh (+) | ||||||||
Juzych, NS (2005) [32] | 3 | URTI | IG: 1, 2, 8 | 4.5 months | 4.5 months | ___ | 2, 3 | Pa (+) (−)b |
CG: 0 | T (+) | |||||||
Smeets, HM (2009) [33] | 2 | RTI | IG: 2, 3, 8 | 6 months | 6 months | 6 months (one year later) | 5, 6 | T (−) |
Ga (−) | ||||||||
CG: 0 | ||||||||
Mandryk, JA (2006) [34] | 1 | URTI | IG: 1, 2, 3, 4 | 33 months | 51 months | ___ | 2 | Ga (+) |
T (+) | ||||||||
Stille, CJ (2008) [35] | 4 | RTI | IG: 1, 2, 8 | --- | --- | 6 months | 1 | At/Bh (+) (−)c |
CG: 0 | ||||||||
Finkelstein, JA (2001) [36] | 4 | Otitis media | IG: 1, 2, 3, 8 | 12 months | 12 months | ___ | 2, 3 | T (+) |
Pharyngitis | CG: 0 | |||||||
Sinusitis | ||||||||
Cold | ||||||||
Bronchitis | ||||||||
Altiner, A (2007) [37] | 4 | Acute cough | IG: 4, 8 | 3 months | ___ | 3 months after 6 weeks 3 months after 1 year after | 5, 6 | T (+) |
CG: 0 | ||||||||
Légaré, F (2010) [38] | 4 | Acute RI | IG: 1, 2 | ___ | ___ | ___ | 2, 3 | T (+) |
CG: 0 | ||||||||
Kiang, KM (2005) [39] | 1 | Respiratory illnesses | IG: 1, 2, 8 | ___ | ___ | ___ | 2, 3 | Ga (+) |
At/Bh (+) | ||||||||
Mohagheghi, MA [40] | 4 | ___ | IG: 2 | 60 months | ___ | 3 months afterwards 1 year afterwards |
2, 3 | T (+) (−)d |
CG: 0 | ||||||||
Irurzun, C (2005) [41] | 1 | Pharyngitis and tonsillitis | IG: 1, 2, 3, 4, 10 | ___ | 12 months | ___ | 2 | T (+) |
Ga (+) | ||||||||
Chalker, J (2005) [42] | 5 | ___ | IG: 2, 4, 11 | ___ | ___ | 3x3 months (one month after each intervention) | 1 | T (+) (−)e |
CG: 0 | ||||||||
Finkelstein, JA (2008) [43] | 4 | ___ | IG: 1, 2, 3, 8 | 24 months | 6 months during 3 years | ___ | 2, 3 | T (+) (−)f |
CG: 0 | Ga (+) | |||||||
Chuc, NTK (2002) [44] | 4 | ARTI | IG: 2, 4, 11 | ___ | ___ | ___ | 2, 3 | T (+) |
Qh (+) | ||||||||
Belongia, EA (2001) [45] | 3 | ARTI | IG: 1, 2, 8 | 6 months | ___ | 6 months (every two years) | 7, 8 | T (+) |
Belongia, EA (2005) [46] | 2 | ___ | IG: 1, 2, 8, 9 | 12 months | 48 months | ___ | 3, 4 | T (+) (−)g |
Greene, RA (2004) [47] | 1 | Acute sinusitis | IG: 1, 2, 3, 13 | 22 months | 14 months | ___ | 2 | Ga (+) |
T (+) | ||||||||
Teng, CL (2007) [48] | 2 | URTI and others | IG: 1, 2, 4 | 3 months | ___ | 3 months | 2 | T (+) |
Awad, AI (2006) [49] | 4 | ___ | CG: 0 | ___ | ___ | 1 and 3 months afterwards | 2, 3 | T (+)h |
IG1: 1, 3 | Ga (+) | |||||||
IG2: 2, 3 | ||||||||
IG3: 3, 4 | ||||||||
Welschen, I (2004) [50] | 4 | ARTI | IG: 1, 2, 3, 8 | 3 months | ___ | 3 months | 2, 3 | T (+) |
Gonzales, R (2004) [51] | 2 | ARTI | IG: 1, 8 | 4 months | 4 months (study period) | 2, 3 | T (+) (−)i | |
Colomina Rodríguez, J (2010) [52] | 1 | ___ | IG: 1, 2, 6, 8 | 48 months | 36 months | 24 months | 5 | T (+) |
Ga (+) | ||||||||
Hickman, DE (2003) [53] | 4 | Acute bronchitis | IG: 1, 2, 8 | 6 months | ___ | 6 months | 2, 3 | T (+) |
CG: 0 | ||||||||
Coenen, S (2004) [54] | 4 | Acute cough | IG: 1, 4 | 3 months | 1 month (without outcomes) | ___ | 2,3 | T (+) |
IG: 0 | Ga (+) (−)j | |||||||
Perz, JF (2002) [55] | 1 | ___ | IG: 1, 2, 8, 9 | 12 months | 12 months | 12 months | 5,6 | T (+) |
CG: 0 | ||||||||
Sondergaard, J (2003) [56] | 4 | RTI | IG: 1, 3 | 3 periods of 3 months | 3 periods of 3 months | 3 months (not shown) | 2,3 | T (−) |
CG: 1 | Ga (−) | |||||||
Doyne, EO (2004) [57] | 4 | ___ | IG: 1, 2, 3, 8 | 12 months | 12 months | ___ | 2,3 | T (+) (−)k |
CG1: 1, 3 | ||||||||
CG: 1 | ||||||||
Bauchner, H (2006) [58] | 5 | Acute otitis media | IG: 1, 2, 3 | ___ | ___ | ___ | 1 | Ga (+) (−)L |
CG: 2 | ||||||||
Christakis, DA (2001) [59] | 4 | Acute otitis media | IG: 6 | 7 months | 8 months | ___ | 2,3 | T (−) |
CG: 0 | Ga (+) | |||||||
Småbrekke, L (2002) [60] | 2 | Acute otitis media | IG: 1, 2, 8 | 4 months | 4 months | ___ | 2,3 | T (+) |
CG: 0 | Ga (+) | |||||||
Bjerrum, L (2011) [61] | 1 | RTI | IG = 2, 3, 9, 10 | 3 weeks (x2years) | 3 weeks (x1 year) | ___ | 2, 3 | T (+) |
Ga (+) | ||||||||
Regev-Yochay, G (2011) [62] | 4 | ___ | IG = 2 | 2 years | 1 year | ___ | 2, 3 | T (+) |
CG = 0 | Ga (+) | |||||||
Llor, C (2011) [63] | 4 | Pharyngitis | IG1 = 2, 8, 10 | 15 days | 15 days | ___ | 2, 3 | T (+) |
IG2 = 2, 8, 10 (sem) | ||||||||
Weiss, K (2011) [64] | 1 | ___ | IG = 1 | 2 years | 7 years | ___ | 2, 3 | T (+) |
CG = 0 | ||||||||
Llor, C (2011) [65] | 4 | Acute pharyngitis | IG = 1, 10 | ___ | ___ | ___ | 1 | Ga (+) |
CG = 1 | ||||||||
McKay, RM (2011) [66] | 1 | ___ | IG = 1, 2, 8, 9 | 9 years | 3 years | ___ | 2 | Pa (+) (−)m |
aIn[24], significantly positive in post-intervention period but no significant change post-follow-up.
bIn[32], while prescriptions for pharyngitis, otitis media and URTI decreased significantly post-intervention, the decrease in the case of bronchitis was not as significant.
cIn[35], comparison between attitudes, knowledge and behavior of physicians in the intervention versus the control group showed no significant differences. Physicians in the intervention group reported that they had changed their prescribing in the preceding 3 years.
dIn[40], after one year, there was a reduction in the percentage of antibiotic prescribing in the intervention group but this was not statistically different from the control group.
eIn[42], interventions resulted in improved antibiotic use, which was statistically significant in the Hanoi but not in the Bangkok study.
fIn[43], there was no significant decrease in one age group (3–24 months).
gIn[56], the reduction in antibiotic prescribing by pediatricians was greater in the control than in the intervention group.
hIn[49], audit and feedback combined with academic detailing or seminars appeared to be more effective in changing antibiotic prescribing practices than audit and feedback alone.
iIn[51], there was a moderate decrease in total antibiotics prescribed but this was not statistically significant.
jIn[54], appropriate antibiotic prescribing improved post-intervention but did not prove statistically significant.
kIn[57], the prescribing rate decreased in all groups but there were no statistically significant differences between groups.
LIn[58], adherence was high though not statistically significant in the intervention group, but, in second episodes there were no differences in adherence, between groups.
mIn[66], utilization rates for acute bronchitis are at the same level as when intervention began, but other acute respiratory tract infections declined.
(a) Disease: URTI – upper respiratory tract infections; RTI – respiratory tract infections; ARTI – acute respiratory tract infections; UTI – urinary tract infections.
(b) Study design (SD): (1) before/after studies; (2) – nonrandomized controlled trial without cross-contamination control; (3) – nonrandomized controlled trial with cross-contamination control; (4) - randomized controlled trial without cross-contamination control; (5) - randomized controlled trial with cross-contamination control.
(c) IG – intervention group; CG – control group.
(d) Type of intervention (TI): (0) no intervention; (1) dissemination of printed/audiovisual educational materials (mailed printed matter; protocols and guidelines; self-instruction materials; drug bulletins); (2) group education, including group-session rounds, conferences, lectures, seminars and tutorials; (3) feedback of physician prescribing patterns (individually or including a comparison of these patterns with peer behavior and/or accepted standards) or feedback of patient-specific lists of prescribed medication; (4) individual outreach visits; (5) reminders at the time of prescribing; (6) computer-assisted decision-making systems; (7) formulary-control/restrictive formulary process; (8) patient education (pamphlets); (9) patient education (videotapes); (10) workshops on rapid tests / introduction of Rapid Antigen Detection Tests (RADTs) in consulting offices; (11) enforcement of regulations; (12) prescription feedback with recommendations to modify it by pharmacists and/or infectious-disease physicians; (13) financial incentives.
(e) Type of data-analysis (T): (1) comparison of post-test values between groups; (2) comparison of pre- and post-values within each group; (3) comparison of pre- and post-values between groups; (4) comparison of follow-up values between groups; (5) comparison of pre-, post- and follow-up values within each group; (6) comparison of pre-, post- and follow-up values between groups.
(f) Results analyzed (R): (T) total antibiotics prescribed/dispensed; (Ga) choice of appropriate antibiotics/adherence to antibiotic guidance according to guideline algorithms, including dosages and routes of administration; (Pa) prescription rate per disease; (At/Bh) attitudes and behavior; (Qph) quality of pharmacy practice.