Abstract
Introduction Although antibiotic use and antimicrobial resistance in the Netherlands is comparatively low, inappropriate prescription of antibiotics is substantial, mainly for respiratory tract infections (RTIs). General practitioners (GPs) experience pressure from patients with an immigration background to prescribe antibiotics and have difficulty communicating in a culturally sensitive way. Multifaceted interventions including communication skills training for GPs are shown to be most effective in reducing antibiotic prescription. The PARCA study aims to reduce the number of antibiotic prescriptions for RTIs through implementing a culturally sensitive communication intervention for GPs and evaluate it in a randomised controlled trial (RCT). Methods and analysis A nonblinded RCT including 58 GPs (29 for each arm). The intervention consists of: (1) An E- learning with 4 modules of 10–15 min each; (2) A facetoface training session in (intercultural) communication skills including role plays with a training actor and (3) Availability of informative patientfacing materials that use simple words (A2/B1 level) in multiple languages. The primary outcome measure is the number of dispensed antibiotic courses qualifying for RTIs in primary care, per 1000 registered patients. The secondary outcome measure is the number of all dispensed antibiotic courses, per 1000 registered patients. The intervention arm will receive the training in Autumn 2021, followed by an observation period of 6 winter months for which numbers of antibiotics will be collected for both trial arms. The GPs/practices in the control arm can attend the training after the observation period. Ethics and dissemination The study protocol was approved by the Medical Ethics Review Committee of Erasmus MC, University Medical Center Rotterdam (MEC- 2020- 0142). The results of the trial will be published in international peerreviewed scientific journals and will be disseminated through national and international congresses. The project is funded by The Netherlands Organisation for Health Research and Development (ZonMw). Strengths and limitations of this study ► This randomised controlled trial (RCT) in cities with large and diverse ethnic communities is unique in its focus on improving the communication of general practitioners (GPs) with their patients with an immigration background. ► Focus group discussions with immigrant patients and interviews with GPs and pharmacists are used to develop the content of a training intervention. ► The RCT includes a process evaluation with pre and post selfevaluations by GPs regarding their skills in culturalsensitive communication, and skills to assess patient expectations and explain antibiotic nonprescribing to immigrant patients. ► Due to data restrictions, the outcome measures include antibiotics that are prescribed for all patients and not solely for immigrants. ► The primary outcome measure, that is, the number of dispensed antibioti