Reducing antibiotic prescribing by enhancing communication of general practitioners with their immigrant patients: protocol for a randomised controlled trial (PARCA study)
Lescure, Dominique; van der Velden, Janneke; Nieboer, Daan; van Oorschot, Wilbert; Brouwer, Rob; Huijser van Reenen, Natascha; Tjon-A-Tsien, Aimée; Erdem, Özcan; Vos, Margreet; van der Velden, Alike; Richardus, Jan Hendrik; Voeten, Hélène
(2021) BMJ Open, volume 11, issue 10, pp. 1 - 7
(Article)
Abstract
INTRODUCTION: Although antibiotic use and antimicrobial resistance in the Netherlands is comparatively low, inappropriate prescription of antibiotics is substantial, mainly for respiratory tract infections (RTIs). General practitioners (GPs) experience pressure from patients with an immigration background to prescribe antibiotics and have difficulty communicating in a culturally sensitive way. Multifaceted interventions
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including communication skills training for GPs are shown to be most effective in reducing antibiotic prescription. The PARCA study aims to reduce the number of antibiotic prescriptions for RTIs through implementing a culturally sensitive communication intervention for GPs and evaluate it in a randomised controlled trial (RCT). METHODS AND ANALYSIS: A non-blinded RCT including 58 GPs (29 for each arm). The intervention consists of: (1) An E-learning with 4 modules of 10-15 min each; (2) A face-to-face training session in (intercultural) communication skills including role plays with a training actor and (3) Availability of informative patient-facing materials that use simple words (A2/B1 level) in multiple languages. The primary outcome measure is the number of dispensed antibiotic courses qualifying for RTIs in primary care, per 1000 registered patients. The secondary outcome measure is the number of all dispensed antibiotic courses, per 1000 registered patients. The intervention arm will receive the training in Autumn 2021, followed by an observation period of 6 winter months for which numbers of antibiotics will be collected for both trial arms. The GPs/practices in the control arm can attend the training after the observation period. ETHICS AND DISSEMINATION: The study protocol was approved by the Medical Ethics Review Committee of Erasmus MC, University Medical Center Rotterdam (MEC-2020-0142). The results of the trial will be published in international peer-reviewed scientific journals and will be disseminated through national and international congresses. The project is funded by The Netherlands Organisation for Health Research and Development (ZonMw). TRIAL REGISTRATION NUMBER: NL9450.
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Keywords: preventive medicine, primary care, public health, General Medicine
ISSN: 2044-6055
Publisher: BMJ Publishing Group
Note: Funding Information: 1Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands 2Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands 3Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, The Netherlands 4Health Centre Zuidplein, Rotterdam, The Netherlands 5Health Centre Levinas, Pharmacy Ramleh, Rotterdam, The Netherlands 6Department of Research and Business Intelligence, Municipality of Rotterdam, Rotterdam, The Netherlands 7Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands 8Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands Contributors WvO, RB, AT-A-A, OE and MCV conceived the study, contributed to the protocol and are consulted yearly about the trial procedure. JvdV and NHVR conceived the study, contributed to the protocol and are actively involved in the development of the intervention. AWvdV conceived the study, contributed to the protocol, and are regularly asked for advice concerning the trial procedure. HV conceived of the study, initiated the study design, has written and composed the protocol, assists with the implementation and is the PhD cosupervisor of DL. DN advised in the statistical analyses and performed the power calculation. JHR conceived of the study, has contributed extensively to the protocol and is the PhD supervisor of DL. DL is implementing the trial, has contributed extensively to the protocol, has written this manuscript, and will be conducting the primary statistical analysis. All authors contributed to refinement of the study protocol and approved the final manuscript. Funding The work is supported by The Netherlands Organisation for Health Research and Development, ZonMw (Postbus 93245, 2509 AE Den Haag, The Netherlands), grant number 50-54100-98-209. Disclaimer ZonMw had no role in the design of this study, and will not have any role during its execution, analyses, interpretation of the data, or decision to submit results. Competing interests None declared. Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details. Publisher Copyright: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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