1. TIDieR intervention summary (Hoffmann 2014).
| Author year | Brief name | Recipient | Why | What (materials) | What (procedures) | Who provided | How | Where | When and how much | Tailoring | Modification of intervention throughout trial | Strategies to improve or maintain intervention fidelity | Extent of intervention fidelity |
| Altiner 2007 | Complex GP peer‐led educational intervention | GPs and patients | Focused on communication within a consultation and the mutual discordance between patients' expectations and doctors' perceived patient expectations, empowering patients to raise the issue within the consultation. By 'informing' both sides in the consultation, it is hoped that doctors and patients would openly talk about the issue and thus reduce unnecessary antibiotic prescriptions | Peers used a semi‐structured dialogue script for outreach visits Patient materials (leaflet and poster) provided in waiting room primarily focused on the patients' role doctor‐patient 'antibiotic misunderstanding' and brief evidence‐based information on acute cough and antibiotics |
GP peer‐led outreach visits. Peers were trained to explore GPs' 'opposite' motivational background to address their beliefs and attitudes. GPs were motivated to explore patient expectations and demands, to elicit anxieties and make antibiotic prescribing a subject in the consultation Patient materials were aimed at empowering patients to raise and clarify issues within the consultation |
5 practising GPs and teaching academics in the lead authors' department (2 female, 33 to 63 years of age); trained in 3 sessions for outreach visits | Face‐to‐face outreach visits to GPs | GP clinics during normal working hours | 1 outreach visit performed per GP (duration not specified) | Not described | Not described | Not described | 51/52 GPs received intervention |
| Briel 2006 | Brief training programme in patient‐centred communication | GPs | Focused on teaching GPs how to understand and modify patients' concepts and beliefs about the use of antibiotics for ARIs. GPs were introduced to a model (Prochaska 1992) for identifying patients' attitude and readiness for behaviour change | Evidence‐based guidelines for diagnosis and treatment of ARIs (updated, locally adapted and reviewed by local experts) distributed as a booklet [URL provided is no longer active] | GPs were trained in elements of active listening, to respond to emotional cues, and to tailor information given to patients. Physicians used a model were introduced to a model (Prochaska 1992) to identify patients' attitude and readiness for behaviour change | Not specified | Seminar in small groups (number not specified) and personal feedback by telephone prior to the start of the trial. Evidence‐based guidelines were distributed as a booklet | Not specified | Attendance at 1 x 6‐hour seminar and 1 x 2‐hour telephone call to give personal feedback prior to the trial start | Not described | Not described | Not described | Not described |
| Butler 2012 | Multifaceted flexible blended learning approach for clinicians | GPs and nurse practitioners | Blended learning experience to develop clinicians' sense of the importance about change and their confidence in their ability to achieve change based on Social Learning Theory Clinicians reflected on practice‐level antibiotic dispensing and resistance data, reflected on own clinical practice (context‐bound learning), and were trained in novel communication skills derived from principles of motivational interviewing |
Summaries of research evidence and guidelines, web‐based modules using video‐rich material presenting novel communication skills, and a web‐based forum to share experiences and views (see www.stemmingthetide.org for online component) |
Intervention consist of 7 components: experiential learning, updated summaries of research evidence and guidelines; web‐based learning in novel communication skills; practising consulting skills in routine care; facilitator‐led practice‐based seminar on practice‐level data on antibiotic prescribing and resistance; reflections on own clinical practice, and a web‐based forum to share experiences and views | A facilitator conducted the face‐to‐face seminar | Intervention consisted of 7 parts (5 online modules, 1 face‐to‐face seminar and 1 facilitator‐led practice‐based seminar) | The face‐to‐face and facilitator‐led seminars were presented at the general practice | 7 components (5 online, 1 face‐to‐face and 1 facilitator‐led practice‐based seminar) A booster module (6 to 8 months after completion of initial training) reinforced these skills |
Intervention was flexible so clinicians could access the online components and try out new skills with their patients at their convenience | Not described | Not described | 138/139 completed all online training and uploaded descriptions of consultations for the portfolio tasks; 129/139 attended the practice‐based seminars; 76/139 completed the optional booster session at 6 months; 11/139 entered new threads on the online forum with 81 posts and 1485 viewings of posts and threads |
| Cals 2009 | Enhanced communication skills training | GPs | Focused on information exchange based on the elicit‐provide‐elicit framework from counselling in behaviour change ‐ exploring patients' fears and expectations, patients' opinion on antibiotics and outlining the natural duration of cough in lower respiratory tract infections | Pre and post‐workshop transcripts of simulated patients | Brief context‐learning based workshop in small groups (5 to 8 GPs), preceded and followed by practice‐based consultations with simulated patients. GPs reflected on own transcripts of consultations with simulated patients, which were also peer‐reviewed by colleagues | Experienced moderator to lead seminars | Brief workshop (5 to 8 GPs), preceded and followed by practice‐based consultation with simulated patients | General practice | 1 x 2‐hour moderator‐led small groups workshop, preceded and followed by practice‐based consultation with simulated patients | Not described | Not described | Not described | 66% of patients recruited by GPs allocated to training in enhanced communication skills recalled their GP's use at least 3 of 4 specific communication skills compared with 19% in the no training group |
| Francis 2009 | Interactive booklet for parents and clinician training in its use | GPs and patients | Focused on specific communication skills, such as exploring parent's main concerns, asking about their expectations, and discussing prognosis, treatment options and reasons that should prompt re‐consultation | 8‐page booklet (now at www.whenshouldIworry.com ); online training in use of the booklet included videos to demonstrate use of the booklet within a consultation, as well as audio feeds, pictures and links to study materials [original URL no longer active] |
Booklet given to parents to use in the consultation and as a take‐home resource (no further details provided) Online training on the use of the booklet was provided to GPs: describing the content and aims of the booklet, and encouraging use within the consultation to facilitate use of specific communication skills |
N/A (online training) | Parents used the booklet face‐to‐face in the consultation with GPs and took it home; GP training in use of booklet was online | General practice; parents' homes | 1 x 40‐minute online training module | Not described | Not described | Online clinician training monitored through study website: whether a GP has logged on to the site, how much time spent on it and which pages were viewed | Stated that treatment fidelity was not measured so that assessors could remain blind to the study group |
| Légaré 2012 | Shared decision making training program (DECISION+2) | Family physicians (including teachers and residents) | A shared decision making training program that aimed to help physicians communicate to patients the probability of a bacterial ARI and the benefits and harms associated with the use of antibiotics | Online tutorial and workshop included videos, exercises and decision aids to help physicians communicate to their patients the probability of bacterial ARIs and benefits/harms of antibiotic use. Decision aids were available in the consultation rooms in all family practice teaching units | Online self tutorial comprising 5 modules 2‐hour online tutorial followed by a facilitator‐led on‐site interactive workshops aimed to help physicians review and integrate concepts acquired during online training | Trained facilitators | Online tutorial and face‐to‐face workshop | Family practice teaching units | 1 x 2‐hour online tutorial, followed by 1 x 2‐hour on‐site interactive workshop. Participants had 1 month to complete the programme | Not described | Not described | Not described | Of the 162 physicians, 103 completed both the online tutorial and workshop; 16 completed only the workshop; 15 only the tutorial; and 28 completed none of the training components |
| Légaré 2011 | Multiple‐component, continuing professional development program in shared decision making (DECISION+) | Family medicine groups (physicians and nurses) | Aimed to help family physicians communicate to patients the probability of bacterial ARI and benefits and harms of antibiotic use | Workshops included videos (simulated consultations of usual care and SDM) and exercises (facilitators and barriers to SDM). GPs trained in the use of 5 decision support tools using video examples and group exercises. A booklet summarising workshop content provided to participants. Postcard reminders sent | Interactive workshops and related material, reminders of expected behaviours and GP feedback on agreement between their decisional conflict and that of their patients | Trained facilitators | Face‐to‐face workshop | Family medicine groups | 3 x 3‐hour interactive workshops and related material, in addition to reminders of expected behaviours and GP feedback on agreement between their decisional conflict and that of their patients. DECISION+ conducted over 4 to 6 months | Not described | 4 pilot workshops held rather than 3 as the second workshop was redesigned and re‐piloted after feedback on its first testing | Not described | Not described |
| Little 2013 | Internet‐based training in enhanced communication skills | GPs | Rationale was that Internet‐based training can be more widely disseminated than face‐to‐face training. Training focused on eliciting patients' expectations and concerns, natural disease course, treatments, agreement on a management plan, summing up and guidance on when to re‐consult | Interactive booklet for use by GPs within consultations Training supported by video demonstrations of consultation techniques | Online modules and an interactive booklet for use within consultations. (Group practices also appointed a lead GP to organise a structured meeting on prescribing issues) | N/A (online modules) other than lead GP at each practice to organise a meeting (not specific to just this arm of the intervention though) | Online modules (and GP‐led structured practice‐based meeting) | General practice | Internet modules completed alone or in a group | Not described | Not described | Not described | 94/108 practices (87%) completed the communication training. Mean (SD) time spent on the website was 37 (29) minutes |
| Welschen 2004 | Group education meeting with consensus procedure and communication skills training | GPs/pharmacists and their assistants, and patients | GPs discussed evidence for antibiotic benefit/risk, and learned communication techniques to explore patients' expectations and concerns, inform about natural course of symptoms, self‐ medication and alarm symptoms. Patient education provided information on the self‐ limiting nature or ARIs, self‐medication and alarm symptoms requiring re‐consultation | Group consensus guidelines and patient waiting room materials (poster/leaflets) | Group education meeting with consensus procedure, with a summary, and guidelines mailed 1 month later to reinforce consensus reached; feedback on prescribing behaviour (post‐ and pre‐intervention insurance claims data) and practice‐level reporting of extent prescribing behaviours aligned with consensus reached; group education session for GP and pharmacists assistants (Dutch guidelines and skills training in patient education); waiting room education al material for patients | Jointly led by GP and pharmacist | Group education meeting for GPs with consensus procedure and communication skills training, Group education for GPs' and pharmacists' assistants, monitoring and feedback on prescribing behaviour, and patient education materials |
Not described | 1 x group education meeting with consensus procedure; 1 x 2‐hour group education session for GP and pharmacists' assistants; monitoring and feedback of prescribing behaviour at 6 months post‐intervention | Not described | Not described | Not described | Not described |
ARI: acute respiratory infection GP: general practitioner N/A: not applicable