Academic Detailing to Influence Outpatient Antibiotic Prescribing

In academic detailing, trained health professionals visit practicing physicians and provide evidence-based information to improve practice quality. In this randomized trial from Norway, researchers examined the effect of academic detailing on antibiotic prescribing for patients with respiratory tract infections. In Norway, general practitioners must participate in continuing education group meetings at regular intervals. Eighty such groups (involving 440 general practitioners) received visits from academic detailers who focused on appropriate use of antibiotics for acute respiratory infections (intervention group) or on appropriate prescribing of drugs other than antibiotics (control group). The physicians received individualized reports that tracked their antibiotic prescribing.

In the intervention group, the proportion of acute respiratory infections for which antibiotics were prescribed decreased significantly from 33.2% (preintervention) to 31.8% (1 year postintervention). In contrast, this proportion increased from 33.4% to 35.0% in the control group. When antibiotics were prescribed in the intervention group (but not the control group), prescribing shifted toward penicillin V (the recommended first-line drug in Norway when an antibiotic is deemed to be appropriate for uncomplicated outpatient respiratory infections) and away from extended-spectrum penicillins, macrolides, and tetracyclines.