Electronic Health Records for Intervention Research: A Cluster Randomized Trial to Reduce Antibiotic Prescribing in Primary Care (eCRT Study)
The Annals of Family MedicinePublished 1 July 2014Open access
Martin Gulliford, Tjeerd van Staa, Alex Dregan, Lisa McDermott, Gerry P McCann, Mark Ashworth
Citations94
SJR quartileQ1
SJR score1.10
SNIP1.69
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Cluster randomized trials may be implemented efficiently in large samples from routine care settings by using primary care electronic health records and future studies should develop and test multicomponent methods for remotely delivered intervention.
Abstract
Cluster randomized trials may be implemented efficiently in large samples from routine care settings by using primary care electronic health records. Future studies should develop and test multicomponent methods for remotely delivered intervention.
Keywords
Immunology and MicrobiologyHealth ProfessionsBusiness, Management and Accounting
Journal of Clinical EpidemiologyExplanatory and Pragmatic Attitudes in Therapeutical Trials
1,260 Citations2009Daniel Schwartz, J Lellouch
Most therapeutic trials are inadequately formulated from the earliest stages of their conception, and it often occurs that one type of approach is ethically less defensible than the other, or may even be ruled out altogether on ethical grounds.
British Journal of Clinical PharmacologyValidation and validity of diagnoses in the General Practice Research Database: a systematic review
1,115 Citations2009Emily Herrett, Sara L. Thomas +3 more
The range of methods used to validate diagnoses in the General Practice Research Database (GPRD) are investigated, to summarize findings and to assess the quality of these validations.
International Journal of EpidemiologySimple sample size calculation for cluster-randomized trials
842 Citations1999Richard Hayes, S. Bennett
The main objective of the program is to increase the colorectal cancer screening participation rate among the deprived population through the intervention of a navigator to promote the Fecal Occult Blood Test (FOBT) and complementary exams.
Bulletin of the World Health OrganizationFactors that promote or inhibit the implementation of e-health systems: an explanatory systematic review
563 Citations2012Frances S Mair, Carl May +4 more
The published literature on the implementation of e-health focused on organizational issues, neglecting the wider social framework that must be considered when introducing new technologies.
BMJTreatment allocation by minimisation
520 Citations2005Douglas G. Altman, Martin Bland
In almost all controlled trials treatments are allocated by randomisation, and the aim is that each allocation should minimise the imbalance across multiple factors.
Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 7: Care Coordination)
502 Citations2007Kathryn M McDonald, Vandana Sundaram +7 more
A working definition of care coordination is developed, applied to a review of systematic reviews, and theoretical frameworks that might predict or explain how care coordination mechanisms are influenced by factors in the health care setting and how they relate to patient outcomes and health care costs are identified.
American Journal of Public HealthPitfalls of and Controversies in Cluster Randomization Trials
448 Citations2004Allan Donner, Neil Klar
This work discusses several topics related to cluster randomized trials, with emphasis on the choices that must be made in the planning stages of a trial and on some potential pitfalls to be avoided.
BMJFeatures of effective computerised clinical decision support systems: meta-regression of 162 randomised trials
443 Citations2013Pavel S Roshanov, Natália Fernandes +10 more
Presenting decision support within electronic charting or order entry systems are associated with failure compared with other ways of delivering advice and several factors that could partially explain why some systems succeed and others fail are identified.
The LancetEffects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial
410 Citations2013Paul Little, Beth Stuart +24 more
Internet training achieved important reductions in antibiotic prescribing for respiratory-tract infections across language and cultural boundaries.
BMJWhy do general practitioners prescribe antibiotics for sore throat? Grounded theory interview study
319 Citations2003Satinder Kumar, Paul Little +1 more
General practitioners have reduced prescribing for sore throat in response to research and policy initiatives and further interventions to reduce prescribing would need to improve identification of patients at risk of complications and be workable in busy clinical situations.
BMJEffectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: practice based randomised controlled trial
307 Citations2012Christopher Butler, Sharon Simpson +14 more
The STAR educational programme led to reductions in all cause oral antibiotic dispensing over the subsequent year with no significant change in admissions to hospital, reconsultations, or costs.
Therapeutic Advances in Drug SafetyRecent advances in the utility and use of the General Practice Research Database as an example of a UK Primary Care Data resource
287 Citations2012Tim Williams, Tjeerd van Staa +2 more
The GPRD has undergone many changes but remains the largest validated and most utilised primary care database in the UK and its use in pharmacoepidemiology stretches back many years with now over 800 original research papers.
Medical CareInterventions to Reduce Unnecessary Antibiotic Prescribing
223 Citations2008Sumant R Ranji, Michael A. Steinman +2 more
QI efforts are effective at reducing antibiotic use in ambulatory settings, although much room for improvement remains, and strategies using active clinician education and targeting management of all ARIs may yield larger reductions in community-level antibiotic use.
PubMedVariations in antibiotic prescribing and consultation rates for acute respiratory infection in UK general practices 1995-2000.
188 Citations2005Mark Ashworth, Judith Charlton +3 more
Journal of Antimicrobial ChemotherapyGeneral practitioners' perceptions of antimicrobial resistance: a qualitative study
179 Citations2006Sharon Simpson, Fiona Wood +1 more
Antimicrobial resistance is only one of a range of important influences on GPs decisions whether or not to prescribe an antibiotic and is not the most immediate, so influences all need to be taken into account when promoting a more cautious use of antibiotics in primary care.
JAMA Internal MedicineA Cluster Randomized Trial of Decision Support Strategies for Reducing Antibiotic Use in Acute Bronchitis
178 Citations2013Ralph Gonzales, T. Anderer +8 more
Implementation of a decision support strategy for acute bronchitis can help reduce the overuse of antibiotics in primary care settings.
BMJPragmatic randomised trials using routine electronic health records: putting them to the test
173 Citations2012Tjeerd van Staa, Ben Goldacre +6 more
Using electronic health records to enter patients into randomised trials of treatments in real time could provide the answer to what to prescribe for a patient in general practice when the choice of treatments has a limited evidence base.
BMJImproving antibiotic prescribing in acute respiratory tract infections: cluster randomised trial from Norwegian general practice (prescription peer academic detailing (Rx-PAD) study)
155 Citations2013Svein Gjelstad, Sevald Høye +4 more
The intervention led to improved antibiotic prescribing for respiratory tract infections in a representative sample of Norwegian general practitioners, and the courses were feasible to the general practitioners.
Statistics in MedicineUnequal cluster sizes for trials in English and Welsh general practice: implications for sample size calculations
125 Citations2001Sally Kerry, Martin Bland
The effect of variability in practice list size on sample size calculations is demonstrated using the General Medical Services Statistics for England and Wales, 1997, and minimum variance weights are shown to be superior to uniform, particularly when clusters are small, and to cluster size weights, particularlywhen clusters are large.
Journal of Public HealthSelective decrease in consultations and antibiotic prescribing for acute respiratory tract infections in UK primary care up to 2006
107 Citations2009Martin Gulliford, Radoslav Latinovic +4 more
Canadian Medical Association JournalRapidly rising clinical trial costs worry researchers
98 Citations2009Roger Collier
The cost of conducting a clinical trial for a drug is rising like mercury on a summer afternoon, a trend that researchers say is hampering the development of new medicines and is bad.
TrialsThe clinically-integrated randomized trial: proposed novel method for conducting large trials at low cost
87 Citations2009Andrew J. Vickers, Peter T. Scardino
The proposed clinically-integrated randomized trial may allow us to enlarge dramatically the number of clinical questions that can be addressed by randomization, so that the marginal cost of putting an additional patient on trial is negligible.
BMC Family PracticeDeveloping a computer delivered, theory based intervention for guideline implementation in general practice
70 Citations2010Lisa McDermott, Lucy Yardley +3 more
Acceptability and satisfaction with computer-delivered prompts to follow guidelines may be increased by working with practitioners to ensure that the prompts will be perceived as valuable tools that can support GPs' practice.
BMC Health Services ResearchAn intervention modelling experiment to change GPs' intentions to implement evidence-based practice: using theory-based interventions to promote GP management of upper respiratory tract infection without prescribing antibiotics #2
63 Citations2008Susan Hrisos, Martin Eccles +5 more
GPs' intended management of URTI was significantly influenced by their confidence in their ability to manage URTI without antibiotics and the consequences they anticipated as a result of doing so, and two targeted behaviour change interventions differentially affected these beliefs.
Journal of the American Medical Informatics AssociationImplementation of the Department of Veterans Affairs' first point-of-care clinical trial
62 Citations2012Leonard DʼAvolio, Ryan Ferguson +10 more
The first pilot of a point-of-care clinical trial (POCCT), adding randomization and other study processes to an electronic medical record (EMR) system, was launched to compare the effectiveness of two insulin regimens.
TrialsCluster randomised trial in the General Practice Research Database: 1. Electronic decision support to reduce antibiotic prescribing in primary care (eCRT study)
32 Citations2011Martin Gulliford, Tjeerd van Staa +9 more
A cluster randomised trial is implemented to test the effectiveness of an electronic record-based intervention at achieving a reduction in antibiotic prescribing at consultations for respiratory illness in patients aged 18 and 59 years old in intervention family practices as compared with controls.
