Effect of a Comprehensive Antibiotic Stewardship Programme on Antibiotic Prescribing for Acute Respiratory Infections in China's Rural Primary Care Facilities: A Cluster-randomised Controlled Trial
Bibliographic record
Abstract
Abstract Rationale: Antibiotic stewardship interventions may reduce antibiotic prescribing. The study aims to assess the effects of comprehensive antibiotic stewardship in reducing antibiotic prescribing for acute respiratory infections. Methods: We conducted a pragmatic, cluster randomized controlled trial conducted in 34 primary care facilities in rural Guangdong Province, China. Clusters were primary care facilities in two counties with a total of 1 million population. We randomized facilities to intervention or control groups in an overall 1:1 ratio stratified by county. We collected prescription data from all outpatients aged 0-75 who visited the primary care facilities during the 12-month baseline and 12-month intervention periods if they received a primary diagnosis of any acute respiratory infection except pneumonia. Interventions: Our intervention included a half-day training session for doctors using evidence-based guidelines on acute respiratory disease, regular prescription review and feedback facilitated by an app linked with electronic medical records. Patients received app-based education. Control facilities received no inputs. Main outcome and measures: The primary outcome was whether a patient was prescribed antibiotics during the 12-month trial period. We measured the percentage of patients hospitalized within 30 days for respiratory illness or sepsis as a safety indicator of withholding antibiotics. Results: We recruited 34 township hospitals (17 per county) and randomized 17 to each treatment group. Between the baseline (1 January 1 2019 to 15 December 2019) and the intervention period (1 March 2020 and 28 February 2021), the antibiotic prescribing rate decreased from 83% (88828/107314) to 26% (14521/54799) in the intervention group and from 84% (61486/72796) to 71% (30340/42440) in the control group. After adjustment for stratum and covariates, the risk difference was -39 percentage points (95% CI: -47, -29; p<0.001). The intervention did not affect the 30-day hospitalization rate with adjusted risk difference of 0·43 percentage points (95% CI: -0·02, 0·8; p = 0·058). Conclusions: In primary care facilities, antibiotic stewardship involving training guidelines, prescription review and feedback resulted in a substantial reduction in antibiotic prescribing rates for acute respiratory infections without safety concerns. Our trial will inform the antibiotic stewardship policy for primary care facilities in China. Trial registration: ISRCTN, ISRCTN96892547
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.005 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".