چکیده (انگلیسی):

Background:There is a strong link between antibiotic consumption and the rate of antibiotic resistance. In Australia,
the vast majority of antibiotics are prescribed by general practitioners, and the most common indication is for acute
respiratory infections. The aim of this study is to assess if implementing a package of integrated, multifaceted
interventions reduces antibiotic prescribing for acute respiratory infections in general practice.
Methods/design:This is a cluster randomised trial comparing two parallel groups of general practitioners in
28 urban general practices in Queensland, Australia: 14 intervention and 14 control practices. The protocol was
peer-reviewed by content experts who werenominated by the funding organization.
This study evaluates an integrated, multifaceted evidence-based package of interventions implemented over a six
month period. The included interventions, which have previously been demonstrated to be effective at reducing
antibiotic prescribing for acute respiratory infections, are: delayed prescribing; patient decision aids; communication
training; commitment to a practice prescribing policy for antibiotics; patient information leaflet; and near patient
testing with C-reactive protein.
In addition, two sub-studies are nested in the main study: (1) point prevalence estimation carriage of bacterial
upper respiratory pathogens in practice staff and asymptomatic patients; (2) feasibility of direct measures of
antibiotic resistance bynose/throat swabbing.
The main outcome data are from Australia’s national health insurance scheme, Medicare, which will be accessed
after the completion of the intervention phase. They include the number of antibiotic prescriptions and the
number of patient visits per general practitioner for periods before and during the intervention. The incidence of
antibiotic prescriptions will be modelled using the numbers of patients as the denominator and seasonal and
other factors as explanatory variables. Results will compare the change in prescription rates before and during
theinterventioninthetwogroupsofpractices.
Semi-structured interviews will be conducted with the general practitioners and practice staff (practice nurse
and/or practice manager) from the intervention practices on conclusion of the intervention phase to assess the
feasibility and uptake of the interventions.
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* Correspondence:m.avent@uq.edu.au
1
The University of Queensland, School of Public Health, Herston, QLD 4006,
Australia
2
The University of Queensland, UQ Centre for Clinical Research, Herston, QLD
4006, Australia
Full list of author information is available at the end of the article
© 2016 Avent et al.Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Aventet al. BMC Family Practice (2016) 17:48
DOI 10.1186/s12875-016-0446-7
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An economic evaluation will be conducted to estimate the costs of implementing the package, and its costeffectiveness in terms of cost per unit reduction in prescribing.
Discussion:The results on the effectiveness, cost-effectiveness, acceptability and feasibility of this package of
interventions will inform the policy for any national implementation.
Trial registration:The GAPS trial is registered under the AustralianNew Zealand Clinical Trials Register, reference
number: ACTRN12615001128583 (registered 26/10/2015).