Modification of general practitioner prescribing of antibiotics by use of a therapeutics adviser (academic detailer)

Aims This was a pilot study of the use of a clinical pharmacist as a therap eutics adviser (academic detailer) to modify antibiotic prescribing by gene ral practitioners. Methods Following a visit by the adviser (March-May), 112 general practitio ners were recruited and randomised to control or active groups. A panel of experts prepared a best practice chart of recommended drugs for upper and l ower respiratory tract infections, otitis media and urinary tract infection s. The adviser made a 10-15 min visit to each prescriber in the active grou p (June-July), Save them the chart and discussed its recommendations briefl y. Doctors in the control group were not visited nor given the chart. Presc ription numbers for all prescribers were obtained from the Commonwealth Hea lth Insurance Commission for the pre(March-May) and postdetailing (August-S eptember) periods using a three month lag time for data collection. Data fo r total numbers of prescriptions and for selected individual antibiotics us ed in these two periods were analysed using nonparametric statistics. Results Prescribing patterns were similar for the control and active groups in the predetailing period. For both groups, there were significant (P<0.0 3) increases (45% for control and 40% for active) in total number of antibi otic prescriptions in the post compared with the predetailing period. This trend was anticipated on the basis of the winter seasonal increase in respi ratory infections. In line with the chart recommendations for first-line tr eatment, doctors in the active group prescribed significantly more amoxycil lin (P<0.02) and doxycycline (P<0.001) in the post vs predetailing periods. By contrast, doctors in the control group prescribed significantly more ce faclor (P<0.03) and roxithromycin (P<0.03), drugs that were not recommended . The total cost of antibiotics prescribed by doctors in the control group increased by 48% $37 150) from the preto postdetailing periods. In the same time period, the costs for the active group increased by only 35% ($21 020 ). Conclusions We conclude that the academic detailing process was successful in modifying prescribing patterns and that it also decreased prescription n umbers and costs. Application of the scheme on a nationwide basis could not only improve prescriber choice of the most appropriate antibiotic but also result in a significant saving of health care dollars.