| Study |
Targeted Behaviour |
Main Process Effect |
Absolute Change |
Relative Change |
Notes |
| Harris 1984 |
Reducing prescribing of oral antibiotics |
Comparison: Educational meetings + audit and feedback vs control
Prescriptions per 1000 registered patients
Before: 16.5 vs 16.0
After 16.7 vs 18.9 |
Absolute change (post): ‐2.2
Difference in absolute change from baseline: ‐2.7 |
Relative percent change (post): ‐6.9% |
Practice level audit and feedback provided four times over two years. Two interactive discussions of audit material |
| Angunawela 1991 |
Reducing prescribing of oral antibiotics |
Comparison: educational meetings + printed educational materials vs control
Proportion of patients prescribed an antibiotic
Before: 38.8% vs 32.2%
After: 31.5% vs 31.8% |
Absolute change (post): ‐0.3%
Difference in absolute change from baseline: ‐6.9% |
Relative percent change (post): ‐0.009% |
No before and after differences within study group were statistically significant by Wilcoxon rank sum test
One meeting per prescriber lasting 3 hours reinforcing printed materials. Not clear if interactive
For comparison of patient educational materials vs control see Table 1 |
| Bexell 1996 |
Reducing prescribing or oral antibiotics |
Comparison: educational meeting vs control
Proportion of patients prescribed an antibiotic
Before: 41.2% vs 41.0%
After: 34.2% vs 42.1% |
Absolute change (post): ‐7.9%
Difference in absolute change from baseline: ‐8.1% |
Relative percent change (post): ‐18.8% |
Three, interactive, two day seminars discussing prescribing guidelines |
| Perez‐Cuevas 1996 |
Improving appropriateness of antibiotic prescribing |
Comparison: educational meeting + peer review vs control (intervention and controls selected from two groups of physicians, SSA and IMSS; results reported separately for these two groups)
Proportion of patients prescribed antibiotics
SSA
Before: 80.7% vs 97.1%
After: 62.7% vs 86.5%
IMSS
Before: 88% vs 95.7%
After: 56.3% vs 96.9% |
SSA
Absolute change (post): ‐23.8%
Difference in absolute change from baseline: ‐7.4%
IMSS
Absolute change (post)(IMSS): ‐40.6%
Difference in absolute change from baseline (IMSS): ‐32.9% |
SSA
Relative percent change (post): ‐27.5%
Relative percent change (post): ‐41.9% |
Follow up of prescribing practices at 18 months showed: persistent positive change (continued improvement in prescribing) for 17.5% of study physicians (from both groups) vs 2.6% of control physicians and a stable positive change (maintained improvement after training but no additional improvement) in 25% of study physicians and 0.0% of control physicians
Five, interactive, two hour, small‐group workshops |
| Santoso 1996 |
Reducing prescribing of antibiotic prescribing for diarrhoea |
Comparison 1: small group educational meeting vs control
Proportion of patients prescribed an antibiotic
Before: 77.4% vs 82.6%
After: 60.4% vs 79.3%
Comparison 2: large group educational meeting vs control
Proportion of patients prescribed an antibiotic
Before: 82.3% vs 82.6%
After: 72.3% vs 79.3% |
Comparison 1:
Absolute change (post): ‐18.9%
Difference in absolute change from baseline: ‐13.7%
Comparison 2:
Absolute change (post): ‐7.0%
Difference in absolute change from baseline: ‐6.7% |
Comparison 1:
Relative percent change (post): ‐23.8%
Comparison 2:
Relative per cent change (post): ‐8.4% |
Change in prescribing in intervention compared with control not statistically significant by chi square
Small group meetings interactive with 8 to 12 participants
Large group meetings were formal, non‐interactive seminars |
| Lundborg 1999 |
Increasing prescribing of first line antibiotics and reducing duration of therapy for urinary tract infection (UTI). Reducing antibiotic prescribing for asthma exacerbations |
Comparison: education meetings + audit and feedback vs control (UTI and asthma groups acted as controls for each other)
Proportion of patients prescribed first‐line antibiotic (UTI)
Before: 52% vs 70%
After: 57% vs 58%
Average duration of treatment (UTI) (days)
Before: 7.51 vs 7.41
After: 7.60 vs 7.44
Number of antibiotic courses per asthma patient
Before: 0.26 vs 0.27
After: 0.32 vs 0.26 |
First line UTI antibiotics
Absolute change (post): ‐1.0%
Difference in absolute change from baseline: 17.0%
Average duration of treatment:
Absolute change (post): 0.16
Difference in absolute change from baseline: 0.06
Number of antibiotic courses per asthma patient
Absolute change (post): 0.08
Difference in absolute change from baseline: 0.07 |
First line UTI antibiotics
Relative percent change (post): ‐1.7%
Average duration of treatment:
Relative percent change (post): 2.2%
Number of antibiotic courses per asthma patient
Relative percent change (post): 30.7% |
Using multilevel regression and paired t‐statistic:
change in proportion of patients prescribed first‐line antibiotics for UTI significant (P value <0.001)
change in average duration of treatment not significant (p> 0.2)
change in number of antibiotic prescriptions per asthma patient not significant (P value >0.2)
Interactive small group (3 to 12 participants), 1.4 hours long discussing audit material, case simulations and guidelines |
| Lagerlov 2000 |
Increasing the proportion of appropriately treated UTI patients (short course therapy) |
Comparison: educational meetings + audit and feedback vs control (similar intervention for different condition ‐ asthma)
Mean proportion of short courses of therapy
Before: 0.12 vs 0.12
After: raw data not available |
Not calculable or provided |
Relative percent change (post): 13.1% |
Using hierarchical regression, the 13.1% increase in prescribing of short courses of antibiotics for UTI in intervention compared with control was statistically significant (P value <0.0001)
2 interactive, 2 to 3 hour long, small‐group (4 to 8 participants) meetings |
| McNulty 2000 |
Reducing prescribing of antibiotics |
Comparison: educational meetings + audit and feedback vs microbiology tutorials
Number of prescriptions for antibiotics
Before: 71 657 vs 53 867
After: 69 199 vs 52 658 |
Absolute change (post): 16541
Difference in absolute change from baseline: ‐1249 |
Relative percent change (post): 31.4% |
P value 0.09 for the change in overall antibiotic between intervention and control groups by Mann‐Whitney U test
One, small‐group, interactive workshop, 1.5‐2 hours long discussing audit material and guidelines vs
One, large, formal, non‐interactive, microbiology lecture |
| Veninga 2000 |
Increasing prescribing of first‐choice antibiotics and reducing duration of therapy for urinary tract infection |
Comparison: educational meetings + audit and feedback vs control (same intervention for asthma)
Proportion of first‐choice antibiotics dispensed for all UTI antibiotics
Before: 89% vs 86%
After: 89% vs 85%
Average duration of UTI therapy (in defined daily doses ‐ DDD)
Before: 6.07 vs 5.40
After: 4.29 vs 5.51 |
First choice antibiotics
Absolute change (post): 4.0%
Difference in absolute change from baseline: 1.0%
Duration of therapy
Absolute change (post): ‐1.22
Difference in absolute change from baseline: ‐1.89 |
First choice antibiotics
Relative percent change (post): 4.7%
Duration of therapy
Relative percent change (post): 22.2% |
Change in duration of UTI therapy significant at P value 0.05 level by hierarchical regression
Self‐learning auditing program for peer groups ‐ small‐group (8 participants), interactive workshops discussing audit material, cases and guidelines |
| Meyer 2001 |
Reducing prescribing for upper respiratory infection and diarrhea |
Comparison: educational meeting vs control
Proportion of prescriptions with an antibiotics (mean value for 2 conditions)
Before: 47.2% vs 32.6%
After: 18.8% vs 25.8% |
Absolute change (post): ‐7.0%
Difference in absolute change from baseline: ‐21.6% |
Relative percent change (post): ‐27.1% |
One, effective prescribing workshops for 20 participants 4 days long, not clear if interactive |
