Let’s Talk About Antibiotics: a randomised trial of two interventions to reduce antibiotic misuse

Background Children with acute respiratory tract infections (ARTIs) receive ≈11.4 million unnecessary antibiotic prescriptions annually. A noted contributor is inadequate parent–clinician communication, however, efforts to reduce overprescribing have only indirectly targeted communication or been impractical.Objectives Compare two feasible (higher vs lower intensity) interventions for enhancing parent–clinician communication on the rate of inappropriate antibiotic prescribing.Design Multisite, parallel group, cluster randomised comparative effectiveness trial. Data collected between March 2017 and March 2019.Setting Academic and private practice outpatient clinics.Participants Clinicians (n=41, 85% of eligible approached) and 1599 parent–child dyads (ages 1–5 years with ARTI symptoms, 71% of eligible approached).Interventions All clinicians received 20 min ARTI diagnosis and treatment education. Higher intensity clinicians received an additional 50 min communication skills training. All parents viewed a 90 second antibiotic education video.Main outcome(s) and measure(s) Inappropriate antibiotic treatment was assessed via blinded medical record review by study clinicians and a priori defined as prescriptions for the wrong diagnosis or use of the wrong agent. Secondary outcomes were revisits, adverse drug reactions (both assessed 2 weeks after the visit) and parent ratings of provider communication, shared decision-making and visit satisfaction (assessed at end of the visit on Likert-type scales).Results Most clinicians completed the study (n=38, 93%), were doctors (n=25, 66%), female (n=30, 78%) and averaged 8 years in practice. All parent–child dyad provided data for the main outcome (n=855 (54%) male, n=1043 (53%)