The ImpProGUIDE study aims to find out whether implementing new Swiss national guidelines for acute respiratory infections (ARI) can help to reduce antibiotic prescribing in primary care. In Switzerland, most antibiotics are prescribed in outpatient care, and many of these prescriptions may not be needed - especially when infections are caused by viruses, which antibiotics do not treat. Reducing overuse of antibiotics is important to slow the spread of antibiotic resistance.
The new guidelines were developed by the Swiss Society for Infectious Diseases (SSI) to support family doctors in managing ARIs, based on a syndromic approach. They recommend the targeted use of point-of-care C-reactive protein (CRP) testing when bacterial infection is suspected, as well as shared decision-making with patients.
This study will be carried out in quality circles (QCs) - small groups of family doctors who meet regularly to discuss and improve clinical practice - and in walk-in clinics in French- and Italian-speaking regions of Switzerland. Each will be randomly assigned to either an "intervention" group or a "control" group.
In the intervention group, QC moderators and medical center directors will receive implementation resources to lead a session and distribute materials to their group in autumn 2025 on the new guidelines. Doctors can then decide whether or not to use the recommendations in their consultations.
In the control group, QCs and centers will continue their regular activities. They will receive access to the same educational materials later, in summer 2026.
Throughout the study, the researchers will collect de-identified data from health insurance billing records to track antibiotic prescribing and the use of diagnostic tests. Doctors and QC moderators will also be invited to complete short online surveys twice a year (10-15 minutes) and may be asked to join optional interviews or group discussions after the winter season.
The study will also explore the effectiveness of the implementation strategies on the adoption of the SSI guidelines, as well as the barriers and facilitators to adoption. This study type is known as a hybrid effectiveness implementation study, simultaneously evaluating an intervention's impact on antibiotic prescribing and the strategies used to implement the new national guidelines in a real-world setting.
Participation in the study is voluntary. Doctors can withdraw at any time. All data will be handled confidentially and in line with Swiss data protection laws.
The study is funded by the Swiss National Science Foundation. No support is received from pharmaceutical companies or manufacturers of diagnostic tests.
Willing to participate in a study mainly conducted in French
Agreeing to participate in evaluation surveys
The clinic offers general practice/primary care medicine consultations, including emergencies
The clinic includes at least five physicians
The clinic has an "Admission to practice charged to Swiss compulsory health insurance"
The clinic plans to still be active in April 2026
Parallel
Training Session on acute respiratory infection guideline within a multifaceted implementation strategy
BehavioralImplementation strategies are deployed within quality circles, consisting of a structured educational session including a PowerPoint presentation, a facilitation guide, clinical vignettes, and printed materials for physicians and patients. The session is designed to support clinical decision-making about antibiotic use for ARI, based on targeted use of CRP and shared decision-making.
Defined daily doses of antibiotics commonly used for acute respiratory infections per 1000 consultations
Defined daily doses (DDD) of selected antibiotics (amoxicillin, co-amoxicillin, clarithromycin, azithromycin) per 1000 consultations, based on de-identified health insurance billing data. These antibiotics represent those most commonly prescribed for pneumonia, acute bronchitis, and upper respiratory tract infections (excluding pharyngitis, sinusitis, and otitis media).
Penetration of acute respiratory infection guidelines
Percentage of physicians who self-declare adoption of the new acute respiratory infection (ARI) guidelines (i.e., treating patients according to the guidelines).
Monthly antibiotic prescribing rate
Monthly prescribing rates expressed as: (1) DDD of antibiotics commonly used for ARI per 1000 consultations, and (2) DDD of total antibiotics per 1000 consultations.
Model-estimated differences in antibiotic use
Multilevel regression coefficients estimating differences in antibiotic use (DDD per 1000 consultations) according to physician, practice, quality circle (QC), walk-in clinic, and patient characteristics.
Model-estimated differences in antibiotic use
Multilevel regression coefficients estimating differences in antibiotic use (DDD per 1000 consultations) according to physician, practice, QC, walk-in clinic and patient characteristics.
Use of diagnostic tests
Number of C-reactive protein (CRP) measurements, blood counts, and chest radiographs per 1000 consultations.
Knowledge about acute respiratory infection management
Knowledge about ARI management according to the new guidelines, measured with a custom questionnaire: "Knowledge questionnaire on the diagnosis and treatment of acute respiratory infections and influenza-like syndromes", (6 questions, of which 3 multiple choice, 3 single choice).
Cost-effectiveness of ARI guideline implementation
Incremental cost-effectiveness ratio (ICER), expressed in CHF per percentage point reduction in antibiotic prescribing, comparing the ARI guideline implementation strategy to routine practice.
Click on the lead sponsor to view all of their trials.
Center for Primary Care and Public Health (Unisante), University of Lausanne, Switzerland
Lead sponsor
University of Zurich, Institute for Implementation Science in Health care
Collaborator
Anresis, Swiss Centre for Antibiotic Resistance, University of Bern, Switzerland
Collaborator
CHUV, Lausanne University Hospitals, Switzerland
Collaborator
Swiss Pharmacy Association, pharmaSuisse
Collaborator
