Effects 4.5 years after an interactive GP educational seminar on antibiotic therapy for respiratory tract infections: a randomized controlled trial

BACKGROUND

The few studies assessing long-term effects of educational interventions on antibiotic prescription have produced conflicting results.

OBJECTIVES

Our aim was to assess the effects after 4.5 years of an interactive educational seminar designed for GPs and focused on antibiotic therapy in respiratory tract infections (RTIs). The seminar was expected to decrease antibiotic prescriptions for any diagnosis.

METHODS

We conducted a randomized controlled parallel-group trial in a Paris suburb (France), with GPs as the randomization unit and prescriptions as the analysis unit. The intervention occurred in September 2004 and the final assessment in March 2009. Among 203 randomized GPs, 168 completed the study, 70 in the intervention group and 98 in the control group. Intervention GPs were randomized to attending only a 2-day interactive educational seminar on evidence-based guidelines about managing RTIs or also 1 day of problem-solving training. The primary outcome was the percentage of change in the proportion of prescriptions containing an antibiotic for any diagnosis in 2009 versus 2004. An intention-to-treat sensitivity analysis was performed using multiple imputation.

RESULTS

After 4.5 years, absolute changes in the primary outcome measure were -1.1% (95% confidence interval: -2.2 to 0.0) in the intervention group and +1.4% (0.3-2.6) in the control group, yielding an adjusted between-group difference of -2.2% (-2.7 to -1.7; P < 0.001). Both intervention modalities had significant effects, and multiple imputation produced similar results.

CONCLUSIONS

A single, standardized and interactive educational seminar targeting GPs significantly decreased antibiotic use for RTIs after 4.5 years.

[A French questionnaire to assess quality of life of the aphasic patient: the SIP-65]

OBJECTIVES

To develop and demonstrate validity and reliability of a aphasic-adapted version of the Sickness Impact Profile (SIP-136), a generic widespread questionnaire used to measure quality of life (QoL).

DESIGN

Survey, outpatient oral interviews.

POPULATION

Aphasic people from 20 to 80 years old, with a time from stroke or trauma of more than 12 months, living at home for more than six months, able to understand the questions with a Z-score profile at Boston Diagnostic Aphasia Examination above average for oral comprehension.

METHOD

1. Developments of the short version of the SIP-136, from a first sample of aphasic people; 35 patients were included with a mean time from stroke or trauma of 17 months. This first step consisted in excluding the least relevant items and/or subscales, rewriting some items to make them easier to understand, studying redundancy by multiple components analysis (MCA) and deleting some redundant items. 2. Validity compared with initial SIP-136 and reliability (inter-rater and test-retest) from a second sample of 55 aphasic people (mean time from stroke or trauma = 23 months).

RESULTS

- 1. The first step of development led to a short version with eight subscales and 65 items (SIP-65) exploring physical, psychological and social components of QoL; it took about 16 min to fill it, less than half of the time necessary for the SIP-136. 2. Linear correlation of the responses between SIP-65 and SIP-136 was good: r = 0.97; p < 10(-6). SIP-65 demonstrated a good test-retest (r = 0.97; p < 10(-6)) and inter-rater (r = 0.92; p < 10(-6)) reliability.

DISCUSSION AND CONCLUSION

SIP-65, a short version of SIP-136, is feasible and clinically sound and must be recommended to assess health-related functional status of French aphasic people.