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Acute Respiratory Tract InfectionsOptimAPNCT05166369

Optimisation of Antibiotic Prescription in Acute Noncomplicated Respiratory Tract Infections in Children (OptimAP Study)

A study testing Communication skills training and Mobile phone application on RTI in people with Acute Respiratory Tract Infections, run by Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau at 4 sites in Spain.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Background: High-volume antibiotic prescribing in primary care is a major driver of antibiotic resistance. Education of physicians and patients can lower prescribing levels, but it frequently relies on highly trained staff. Read more about this study

Who is it for?
Ages 18 to 65 yearsHealthy volunteers can take part
Conditions the study is for
Acute Respiratory Tract Infections
What is being tested?
Communication skills training and Mobile phone application on RTI
Could I receive a placebo?
No, everyone receives an active treatment
How many people
222 participants
Where
4 sitesSpain
Study dates
3 Jan 2022to 5 Sep 2023
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 65 years
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Healthcare professionals who care for children in primary care centres and community pharmacists of reference in four Autonomous Communities of Spain (Catalonia, Balearic Islands, Navarra and Basque Country).

Who cannot join

  • None

Trial locations and contacts

4 sites in 1 country.

Spain4 sites
  • Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau

    Barcelona, 08041

  • Institut d'Investigació de les Illes Balears (IdISBa)

    Palma de Mallorca, Balearic Islands, 07120

  • Servicio Navarro de Salud - Osasunbidea

    Pamplona

  • Osakidetza - Ambulatorio de Pasai San Pedro

    Pasaia, Gipuzkoa, 20110

Other trials in Spain

About this study

Official title: Optimisation of Antibiotic Prescription in Acute Non-complicated Respiratory Tract Infections in Children: a Multicenter Factorial Randomised Controlled Trial Targeting Health Professionals and Parents.

Background: High-volume antibiotic prescribing in primary care is a major driver of antibiotic resistance. Education of physicians and patients can lower prescribing levels, but it frequently relies on highly trained staff. We will assess whether remotely delivered complex interventions including internet-based training for health care provider, and an educational intervention for parents could improve prescribing practices for respiratory tract infections (RTI) in Spain.

Methods: We will develop and evaluate the feasibility of two interventions in a 16-months randomized controlled factorial trial. Primary care (PC) centres will be allocated to one of the following four groups:

Read more
  1. Intervention targeting healthcare providers (paediatricians, nurses and pharmacists): i) Internet based training about communication skills and optimal antibiotic prescribing (including delayed prescribing); ii) bimonthly antibiotic prescription feedback.
  2. Intervention targeting parents: PC centres allocated to this group will display posters and flyers presenting a mobile app that will include information about respiratory tract infections and optimal use of antibiotics. The app can be used before, during and after the consultation, providing condition specific and patient tailored information.
  3. Intervention targeting both providers and parents
  4. No intervention.

During the trial duration we will conduct a process evaluation and a cost-effectiveness analysis. Our primary outcome will be change in the total antibiotic prescription rate. Our secondary outcomes will include: respiratory complications (e.g. pneumonia), antibiotic related adverse effects, repeated consultations, and antibiotic consumption in relation with antibiotic prescribing (delayed antibiotic prescribing). Assuming an average cluster size of 200 RTI consultations per centre, we will need to recruit 222 PC centres.

Read the detailed description

This project will evaluate the effectiveness of two complex interventions to optimize the use of antibiotics in acute uncomplicated respiratory tract infections (RTI). We will first develop the different components of the interventions and evaluate their feasibility (user testing). We will then conduct a multicenter, randomized, controlled trial to evaluate the effectiveness of the overall intervention and its two main constituents in reducing antibiotic consumption. For this reason we will implement a 2x2 factorial randomized cluster clinical trial based on healthcare practices. They will be randomized to receive the intervention targeted to parents, intervention targeted health care professionals, both interventions, or none of them. We will need to recruit a sample size of 222 primary care centres, allocated in a ratio of 1:1:1:1 to one of the four intervention groups (assuming an average cluster size of 200 RTI consultations per centre). Study setting will be defined as primary care centres in four Autonomous Communities in Spain (Catalonia, Balearic Islands, Navarra and Basque Country) with a total of more than 600 PC centers, 1,200 pediatricians, and more of one million children. Finally, during the trial duration, we will conduct a process evaluation and an economic evaluation with a cost-effectiveness analysis.

The interventions include the main characteristics of successful interventions to reduce antibiotic prescribing identified in a systematic review: engage children, occur prior to an illness episode, employ delayed prescribing, and provide guidance on specific symptoms (Andrews 2012). Furthermore, the factorial design will inform about their relative merits and the process evaluation about the potential effect of the individual components.

The research team in in Barcelona (Spain) will coordinate the overall running of the project. A research coordinator in Barcelona will run the day to day of the project from day one under the supervision of the principal investigator. The research teams in four different Spanish Autonomous Communities will contribute to all the stages (intervention development, clinical trial, and economic and process evaluation). Patient representatives will be involved in the project as co-investigators and members of the Steering Committee. Throughout the project groups of parents at each of the regions will be providing feedback.

Being tested
Communication skills training, Mobile phone application on RTI
Keywords
Acute respiratory tract infection, Microbial Antibiotic Resistance, Communication skills training, Mobile app-based health information and education

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Communication skills trainingBehavioural

    This intervention consists of a course on communication skills for healthcare professionals.

    It will be done remotely via the internet and will include: communication skills training and optimal management of acute non-complicated RTI and delayed antibiotic prescription. Training modules will be delivered via a specific website password protected. Healthcare professionals will also receive a by-monthly feedback about the rate of antibiotic prescription and consumption for RTI.

  • Mobile phone application on RTIBehavioural

    This intervention involves the use of a mobile phone application by parents and caregivers.

    The mobile app will provide information, education and interactive tools about acute noncomplicated respiratory tract infections.

    PC centres allocated to this group will display posters and flyers to inform parents and caregivers about the mobile app. Healthcare staff will also promote the use of this app by parents and caregivers.

    The app information will be useful before the consultation, and will also allow the patient to interact with the physician during the consultation, potentially improving share decision-making.

    Importantly, the app will allow tailoring the guidance provided according to the type of infection or the number of days with symptoms.

    Healthcare professionals in the primary care centres allocated to this group will also receive a by-monthly feedback about the rate of antibiotic prescription and consumption for RTI.

Study groups in NCT05166369
Study groupRoleWhat they receive
Intervention targeted to healthcare providers (paediatricians, nurses and pharmacists) (ITHP)ExperimentalProfessionals in the PC centres allocated to this group will receive a complex intervention, delivered remotely, which will include the following components: i) Web based training that will include: communication skills training and optimal management of acute non-complicated RTI, including a specific training on delayed antibiotic prescription. ii) By-monthly feedback about the rate of antibiotic prescription and consumption for RTI, center level and individual pediatrician level (information automatically gathered from electronic health records).
Receives: Behavioral: Communication skills training
Intervention targeted to parents (ITP)ExperimentalPC centres allocated to this group will display posters and flyers to inform parents and/or caregivers about a mobile app. It will provide detailed information about respiratory tract infections and optimal use of antibiotics. The app will include information that will be of use before the consultation, but it will also allow the patient to interact with the physician during the consultation, potentially improving share decision-making. Importantly, the app will allow tailoring the guidance provided according to the type of infection or number of days with symptoms. The app will be accessible through an app store or directly using a QR (quick response) code to facilitate uptake. Professionals in the primary care centres allocated to this group will also receive a by-monthly feedback about the rate of antibiotic prescription and consumption for RTI, at center level and individual pediatrician level (information automatically gathered from electronic health records).
Receives: Behavioral: Mobile phone application on RTI
Intervention targeted to patients and/or patient´s parents and to the healthcare providers (ITHP*P)ExperimentalCentres allocated to this group will receive the two interventions described above (intervention targeted to parents plus intervention targeted to providers).
Receives: Behavioral: Communication skills training; Behavioral: Mobile phone application on RTI
Control groupNo interventionThe centers allocated to this arm of the study will continue with their usual care. To avoid a potential Hawthorne effect (observer effect) these centers will not be informed about their participation as controls.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Total antibiotic prescription rate

    Total antibiotic prescription rate for patients between 0 and 14 years old (children).

    Measured: Three months (from 1st January 2022 to 31st March 2022)

Secondary outcomes (4)
  1. RTI complication rate

    Rate of clinical complications of respiratory tract infection (e.g. pneumonia, otitis media, sinusitis).

    Measured: Three months (from 1st January 2022 to 31st March 2022)

  2. Hospital admission rate due to RTI

    Hospital admission rate due to a RTI or a related complication at 30 days after index RTI consultation.

    Measured: Three months (from 1st January 2022 to 31st March 2022)

  3. RTI Re-consultation rate

    RTI re-consultations rates at 7, 14, or 31 days after index RTI consultation.

    Measured: Three months (from 1st January 2022 to 31st March 2022)

  4. Antibiotic-related adverse events rate

    Antibiotic-related adverse events rate (as registered in clinical records).

    Measured: Three months (from 1st January 2022 to 31st March 2022)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted21 Dec 2021
  2. Study start3 Jan 2022
  3. Primary completion4 Sep 2023
  4. Study completion5 Sep 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Factorial
Model description
Multicenter, cluster, randomized, factorial, controlled trial.
Masking
None (open label)
Enrolment
222 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05166369
Sponsor's protocol ID
19/019-P
Acronym
OptimAP
Status last verified
Sep 2023
First submitted
24 Nov 2021
Last updated
28 Sep 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: There is not specific individual participant data, but primary care centre data sets.

Publications

  • Andrews T, Thompson M, Buckley DI, Heneghan C, Deyo R, Redmond N, Lucas PJ, Blair PS, Hay AD. Interventions to influence consulting and antibiotic use for acute respiratory tract infections in children: a systematic review and meta-analysis. PLoS One. 2012;7(1):e30334. doi: 10.1371/journal.pone.0030334. Epub 2012 Jan 27.

    PubMed 22299036
  • Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ. 2010 May 18;340:c2096. doi: 10.1136/bmj.c2096.

    PubMed 20483949
  • Ranji SR, Steinman MA, Shojania KG, Gonzales R. Interventions to reduce unnecessary antibiotic prescribing: a systematic review and quantitative analysis. Med Care. 2008 Aug;46(8):847-62. doi: 10.1097/MLR.0b013e318178eabd.

    PubMed 18665065
  • Little P, Stuart B, Francis N, Douglas E, Tonkin-Crine S, Anthierens S, Cals JW, Melbye H, Santer M, Moore M, Coenen S, Butler C, Hood K, Kelly M, Godycki-Cwirko M, Mierzecki A, Torres A, Llor C, Davies M, Mullee M, O'Reilly G, van der Velden A, Geraghty AW, Goossens H, Verheij T, Yardley L; GRACE consortium. Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial. Lancet. 2013 Oct 5;382(9899):1175-82. doi: 10.1016/S0140-6736(13)60994-0. Epub 2013 Jul 31.

    PubMed 23915885

Questions about this trial

What is this clinical trial studying?

A study testing Communication skills training and Mobile phone application on RTI in people with Acute Respiratory Tract Infections, run by Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau at 4 sites in Spain.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 28 Sep 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 4 sites in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Total antibiotic prescription rate (time frame: Three months (from 1st January 2022 to 31st March 2022)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05166369, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Sep 2023.

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