Effect of educational outreach on general practice prescribing of antibiotics and antidepressants: a two-year randomised controlled trial

Scand J Prim Health Care. 2009;27(4):195-201. doi: 10.3109/02813430903226530.


Objective: Prescribing of broad spectrum antibiotics and antidepressants in general practice often does not accord with guidelines. The aim was to determine the effectiveness of educational outreach in improving the prescribing of selected antibiotics and antidepressants, and whether the effect is sustained for two years.

Design: Single blind randomized trial.

Setting: Twenty-eight general practices in Leicestershire, England.

Intervention: Educational outreach visits were undertaken, tailored to barriers to change, 14 practices receiving visits for reducing selected antibiotics and 14 for improving antidepressant prescribing.

Main outcome measures: Number of items prescribed per 1000 registered patients for amoxicillin with clavulanic acid (co-amoxiclav) and quinolone antibiotics, and average daily quantities per 1000 patients for lofepramine and fluoxetine antidepressants, measured at the practice level for six-month periods over two years.

Results: There was no effect on the prescribing of co-amoxiclav, quinolones, or fluoxetine, but prescribing of lofepramine increased in accordance with the guidelines. The increase persisted throughout two years of follow-up.

Conclusion: A simple, group-level educational outreach intervention, designed to take account of identified barriers to change, can have a modest but sustained effect on prescribing levels. However, outreach is not always effective. The context in which change in prescribing practice is being sought, the views of prescribers concerning the value of the drug, or other unrecognised barriers to change may influence the effectiveness of outreach.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Amoxicillin-Potassium Clavulanate Combination / administration & dosage
  • Anti-Bacterial Agents / administration & dosage*
  • Antidepressive Agents, Second-Generation / administration & dosage*
  • Antidepressive Agents, Tricyclic / administration & dosage*
  • Child
  • Drug Prescriptions / statistics & numerical data*
  • Education, Medical, Continuing / methods
  • Family Practice
  • Female
  • Fluoxetine / administration & dosage
  • Follow-Up Studies
  • Guideline Adherence
  • Humans
  • Lofepramine / administration & dosage
  • Male
  • Outcome Assessment, Health Care
  • Physicians, Family / education
  • Physicians, Family / psychology
  • Practice Patterns, Physicians'*
  • Quinolones / administration & dosage
  • Single-Blind Method


  • Anti-Bacterial Agents
  • Antidepressive Agents, Second-Generation
  • Antidepressive Agents, Tricyclic
  • Quinolones
  • Fluoxetine
  • Amoxicillin-Potassium Clavulanate Combination
  • Lofepramine