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Empowering change – experience of a pragmatic study |
In order to test whether trial evidence could be translated into our daily family-doctor practice in the UK, we devised a strategy based on the results of a Cochrane review assessing the efficacy of antibiotic prescribing for children with ear infections. There is widespread concern about excessive prescribing of antibiotics, but changing practice is not easy due to fears of complications, increased workload and patient dissatisfaction. We considered the barriers faced by doctors and parents in making a change in practice and wrote a handout summarising the evidence. We also offered a deferred prescription for the antibiotic, and compared our antibiotic usage with a control practice.
We found that it was possible to change practice and reduce antibiotic usage in the midst of a busy working practice, and our experience now is that parents are no longer phoning for an appointment for the child the moment they complain of earache. Like the ripples on a pond this change in practice has spread to local practices, and then after publication in the BMJ to other practices across different countries. The paper was presented to the National Pediatric Infectious Disease Group in Aspen Colorado in August 1999 and was voted the top infectious disease article of the year and the approach using a deferred prescription was successfully adopted in a trial in the USA, which was published in 2003.
This year the American Academy of Pediatrics and the American Academy of Family Physicians guideline has been revised to include deferring antibiotics for children with ear infections who are not unduly ill, and have cited the Cochrane review, the BMJ paper from the UK and the follow-up study in the USA.
I will present the experience that we had in using evidence to empower patients and doctors to change practice, and the lessons that we learnt in the process.