RT Journal Article SR Electronic T1 Intervention to improve the quality of antimicrobial prescribing for urinary tract infection: a cluster randomized trial JF Canadian Medical Association Journal JO CMAJ FD Canadian Medical Association SP cmaj.150601 DO 10.1503/cmaj.150601 A1 Akke Vellinga A1 Sandra Galvin A1 Sinead Duane A1 Aoife Callan A1 Kathleen Bennett A1 Martin Cormican A1 Christine Domegan A1 Andrew W. Murphy YR 2015 UL http://www.cmaj.ca/content/early/2015/11/16/cmaj.150601.abstract AB Background: Overuse of antimicrobial therapy in the community adds to the global spread of antimicrobial resistance, which is jeopardizing the treatment of common infections.Methods: We designed a cluster randomized complex intervention to improve antimicrobial prescribing for urinary tract infection in Irish general practice. During a 3-month baseline period, all practices received a workshop to promote consultation coding for urinary tract infections. Practices in intervention arms A and B received a second workshop with information on antimicrobial prescribing guidelines and a practice audit report (baseline data). Practices in intervention arm B received additional evidence on delayed prescribing of antimicrobials for suspected urinary tract infection. A reminder integrated into the patient management software suggested first-line treatment and, for practices in arm B, delayed prescribing. Over the 6-month intervention, practices in arms A and B received monthly audit reports of antimicrobial prescribing.Results: The proportion of antimicrobial prescribing according to guidelines for urinary tract infection increased in arms A and B relative to control (adjusted overall odds ratio [OR] 2.3, 95% confidence interval [CI] 1.7 to 3.2; arm A adjusted OR 2.7, 95% CI 1.8 to 4.1; arm B adjusted OR 2.0, 95% CI 1.3 to 3.0). An unintended increase in antimicrobial prescribing was observed in the intervention arms relative to control (arm A adjusted OR 2.2, 95% CI 1.2 to 4.0; arm B adjusted OR 1.4, 95% CI 0.9 to 2.1). Improvements in guidelinebased prescribing were sustained at 5 months after the intervention.Interpretation: A complex intervention, including audit reports and reminders, improved the quality of prescribing for urinary tract infection in Irish general practice. Trial registration: ClinicalTrials.gov, no. NCT01913860