gms | German Medical Science

Komplexe Interventionen – Entwicklung durch Austausch: 13. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin

Deutsches Netzwerk Evidenzbasierte Medizin e. V.

15.03. - 17.03.2012, Hamburg

Routine peer benchmarking to lower antibiotic prescription in primary care – a pragmatic randomised trial to evaluate a complex intervention

Meeting Abstract

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  • corresponding author presenting/speaker Heiner C. Bucher - Basel Institute for Clinical Epidemiology & Biostatistics, Basel, Switzerland

Komplexe Interventionen – Entwicklung durch Austausch. 13. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin. Hamburg, 15.-17.03.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. Doc12ebm036

doi: 10.3205/12ebm036, urn:nbn:de:0183-12ebm0368

Veröffentlicht: 5. März 2012

© 2012 Bucher.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.



Background: Excessive use of antibiotics may raise bacterial resistance, an increasingly serious problem in Europe. In absolute terms most antibiotics (AB) are prescribed in primary care.

Aim: To evaluate the effect of a continuous postal and web-based peer benchmark system of individual AB prescription rates to lower AB prescription in primary care physicians in Switzerland.

Methods: We plan a randomized, controlled, pragmatic intervention trial in primary care providers of Switzerland above the median of AB prescription rates that are enlisted with social health insurance companies that provide invoice data to the Santésuisse. The primary endpoint is the prescription rate of AB as defined daily doses (DDD) per 100 consultations at 12 and 24 months. Secondary endpoints are costs-savings from the intervention, acceptability of the program, prescriptions fulfilling quality criteria by the European Surveillance of Antimicrobial Consumption.

Intervention: Quarterly postal and electronic feedback for 24 months on the crude number of AB prescribed, a population adjusted benchmark-profile in comparison to other primary care physicians, and evidence-based guidelines for the use of AB in primary care. Physicians in the control group receive no information.

Expected results: We expect a 5% reduction of AB prescription rates between the intervention and control groups after 12 months and the intervention program to be cost-saving. Analysis will be by intention to treat with appropriate adjustment for patient case mix and self-dispensation. We will randomise 1,427 physicians each for the intervention and control group. The web-platform will be presented.

Significance: This trial will investigate if a web-based benchmark system results in a long-term reduction of AB prescription practices. In addition, the feasibility of a web-based interface as communication tool to primary care physicians will be assessed. If effective, the system could be easily employed for other interventions.