PT - JOURNAL ARTICLE AU - Sigurd Høye AU - Svein Gjelstad AU - Morten Lindbæk TI - Effects on antibiotic dispensing rates of interventions to promote delayed prescribing for respiratory tract infections in primary care AID - 10.3399/bjgp13X674468 DP - 2013 Nov 01 TA - British Journal of General Practice PG - e777--e786 VI - 63 IP - 616 4099 - http://bjgp.org/content/63/616/e777.short 4100 - http://bjgp.org/content/63/616/e777.full SO - Br J Gen Pract2013 Nov 01; 63 AB - Background Delayed antibiotic prescribing is an effective method of reducing the consumption of antibiotics for respiratory tract infections (RTIs). However, interventions to promote its use remain unexplored.Aim To measure the effects of a GP educational intervention and a computer delayed-prescribing pop-up reminder on antibiotic-dispensing rates. The study also aimed to identify factors influencing GPs’ decisions to issue delayed prescriptions and patients’ decisions to fill their prescriptions.Design and setting Controlled trial nested within a cluster-randomised controlled trial in urban and rural practices in 11 counties in southern Norway.Method Educational intervention and control groups were randomly populated from 81 continuing medical education groups. Within the intervention arm, 107 of the 156 participating GPs were assigned, based on the electronic patient-record system they used, to having a pop-up reminder installed on their computers. Data on prescribed and dispensed antibiotics from 1 year before, and 1 year during, the intervention were collected and linked.Results Valid data were obtained from 328 GPs (75%). At baseline, 92.1% of prescriptions were filled at pharmacies. The effect of the educational intervention was a 1% reduction in approximated risk (risk ratio [RR] 0.99, 95% confidence interval [CI] = 0.96 to 1.01) of antibiotics being dispensed, while the combined effect of the educational and pop-up reminder intervention was a 4% reduction in approximated risk (RR 0.96, 95% CI = 0.94 to 0.98). In the pop-up intervention group, 11.0% of the prescriptions were issued as delayed prescriptions and 59.2% of these were filled. Upper RTI, sinusitis, and otitis gave highest odds for delayed prescribing and lowest odds for dispensing.Conclusion Promoting delayed prescribing among GPs results in a small decrease in antibiotic dispensing. The savings potential is greatest for upper RTI, sinusitis, and otitis.