PT  - JOURNAL ARTICLE
AU  - Dorota Juszczyk
AU  - Judith Charlton
AU  - Lisa McDermott
AU  - Jamie Soames
AU  - Kirin Sultana
AU  - Mark Ashworth
AU  - Robin Fox
AU  - Alastair D Hay
AU  - Paul Little
AU  - Michael V Moore
AU  - Lucy Yardley
AU  - A Toby Prevost
AU  - Martin C Gulliford
TI  - Electronically delivered, multicomponent intervention to reduce unnecessary antibiotic prescribing for respiratory infections in primary care: a cluster randomised trial using electronic health records—REDUCE Trial study original protocol
AID  - 10.1136/bmjopen-2015-010892
DP  - 2016 Aug 01
TA  - BMJ Open
PG  - e010892
VI  - 6
IP  - 8
4099  - http://bmjopen.bmj.com/content/6/8/e010892.short
4100  - http://bmjopen.bmj.com/content/6/8/e010892.full
SO  - BMJ Open2016 Aug 01; 6
AB  - Introduction Respiratory tract infections (RTIs) account for about 60% of antibiotics prescribed in primary care. This study aims to test the effectiveness, in a cluster randomised controlled trial, of electronically delivered, multicomponent interventions to reduce unnecessary antibiotic prescribing when patients consult for RTIs in primary care. The research will specifically evaluate the effectiveness of feeding back electronic health records (EHRs) data to general practices.Methods and analysis 2-arm cluster randomised trial using the EHRs of the Clinical Practice Research Datalink (CPRD). General practices in England, Scotland, Wales and Northern Ireland are being recruited and the general population of all ages represents the target population. Control trial arm practices will continue with usual care. Practices in the intervention arm will receive complex multicomponent interventions, delivered remotely to information systems, including (1) feedback of each practice's antibiotic prescribing through monthly antibiotic prescribing reports estimated from CPRD data; (2) delivery of educational and decision support tools; (3) a webinar to explain and promote effective usage of the intervention. The intervention will continue for 12 months. Outcomes will be evaluated from CPRD EHRs. The primary outcome will be the number of antibiotic prescriptions for RTIs per 1000 patient years. Secondary outcomes will be: the RTI consultation rate; the proportion of consultations for RTI with an antibiotic prescribed; subgroups of age; different categories of RTI and quartiles of intervention usage. There will be more than 80% power to detect an absolute reduction in antibiotic prescription for RTI of 12 per 1000 registered patient years. Total healthcare usage will be estimated from CPRD data and compared between trial arms.Ethics and dissemination Trial protocol was approved by the National Research Ethics Service Committee (14/LO/1730). The pragmatic design of the trial will enable subsequent translation of effective interventions at scale in order to achieve population impact.Trial registration number ISRCTN95232781; Pre-results.