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Acute Respiratory InfectionImpProGUIDENCT07396428

Effectiveness and Implementation of a National Guideline for Acute Respiratory Tract Infections to Reduce Antibiotic Prescribing in Swiss Primary Care

A study testing Training Session on acute respiratory infection guideline within a multifaceted implementation strategy in people with Acute Respiratory Infection and Influenza-like Illness, run by Center for Primary Care and Public Health (Unisante), University of Lausanne, Switzerland at 1 site in Switzerland.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

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. Read more about this study

Who is it for?
Any age
What is being tested?
Training Session on acute respiratory infection guideline within a multifaceted implementation strategy
Could I receive a placebo?
No, everyone receives an active treatment
How many people
200 participants
Where
1 siteSwitzerland
Study dates
19 May 2025to Nov 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

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 Any age
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • 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
Show all 20Show fewer
  • Located in one of the following cantons: Vaud, Geneva, Valais, Fribourg, Jura, Neuchatel, Bern, Ticino.
  • Serving mainly adult patients
  • Willing to participate in the study
  • Physicians in QCs fulfilling all of the following inclusion criteria are eligible for the study:
  • Registered primary care physicians
  • Specialist title in general internal medicine or practicing physician.
  • Practicing in one of the following cantons: Vaud, Geneva, Valais, Fribourg, Jura, Neuchatel, Bern, Ticino.
  • Participating in a QC or working in an outpatient clinic participating in the study*.
  • Willing to participate in a study mainly conducted in French.
  • Agreeing to participate in evaluation surveys and agreeing to be invited to interviews
  • Eligibility criteria for physicians in clinics :
  • Having a clinical activity as primary care physician or supervising clinical activity of physicians in post-graduate training within a clinic included in the study
  • The only exclusion criterion for physicians is planning to retire before April 2026.
  • Note: not all physicians from a QC or a clinic are expected or required to participate individually in the study, but at least one should participate.

Who cannot join

  • Not having any physician included in the study

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Switzerland1 site, 1 recruiting
  • Unisanté

    Lausanne, Canton of Vaud, 1011

    Jelena Dunaiceva, MPH, +41 78 654 23 75, jelena.dunaiceva@unisante.ch

    Yolanda Mueller, MD, PhD

    Recruiting

Other trials in Switzerland

About this study

Official title: Effectiveness and Implementation of a National Guideline for Acute Respiratory Tract Infections to Reduce Antibiotic Prescribing in Swiss Primary Care: the ImpProGUIDE Hybrid Type II Effectiveness-implementation Trial

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.

Read more

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.

Being tested
Training Session on acute respiratory infection guideline within a multifaceted implementation strategy
Keywords
family medicine, primary care, implementation, hybrid design, effectiveness-implementation study, general medicine, outpatient, antibiotics, antibiotic prescribing, antimicrobial resistance, antimicrobial stewardship, guidelines, shared decision making, CRP, c-reactive protein

What participants receive

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

  • Training Session on acute respiratory infection guideline within a multifaceted implementation strategyBehavioural

    Implementation 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.

Study groups in NCT07396428
Study groupRoleWhat they receive
Acute respiratory infection guideline implementationExperimentalQuality circles (QC) and walk-in clinics randomized to the intervention arm will receive an overarching multifaceted implementation strategy for the new acute respiratory infection (ARI) guidelines. This includes educational materials to help the QC moderators or the person responsible for education in the clinic to lead a thematic session in autumn 2025, focusing on the use of a syndromic approach, targeted C-reactive protein (CRP) testing when bacterial infection is suspected, and shared decision-making with patients. Other facets include an information sheet and pocket card for physicians, and patient leaflets on acute cough.
Receives: Behavioral: Training Session on acute respiratory infection guideline within a multifaceted implementation strategy
Usual careNo interventionQCs and walk-in clinics randomized to the control arm will continue their routine activities without receiving the educational materials on the new guidelines during the initial phase. In the summer 2026, these groups will be offered the same training materials provided to the intervention arm, with the option to use them in their QC sessions or internal training.

What is being measured

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

  1. 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).

    Measured: Over the influenza-like illness (ILI) season (6 months).

  2. 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).

    Measured: Baseline and after 6 months.

Secondary outcomes (26)
  1. 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.

    Measured: Monthly for 12 months.

  2. 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.

    Measured: Over the ILI season (6 months).

  3. 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.

    Measured: Over 12 months.

  4. Use of diagnostic tests

    Number of C-reactive protein (CRP) measurements, blood counts, and chest radiographs per 1000 consultations.

    Measured: Over the ILI season (6 months).

  5. Perceived acceptability of the CRP flowchart

    Perceived acceptability of the CRP flowchart, measured using a French translation of the "Acceptability of Intervention Measure" (5-point Likert scale, higher score means better outcome).

    Measured: Baseline and after 6 months.

  6. Perceived acceptability of the CRP flowchart assessed by custom questions

    Perceived acceptability of the CRP flowchart, assessed using study-specific custom questions (e.g. "I generally agree with prescribing antibiotics in patients with an acute respiratory infection and a CRP level ≥ 100 mg/L." (question originally asked in French), with answer options according to a 5-point Likert scale, higher scores indicate better outcomes).

    Measured: Baseline and after 6 months.

  7. Perceived acceptability of shared decision-making

    Perceived acceptability of shared decision-making, measured using a French translation of the "Acceptability of Intervention Measure" (5-point Likert scale, higher score means better outcome).

    Measured: Baseline and after 6 months.

  8. Perceived acceptability of shared decision-making assessed by custom questions

    Perceived acceptability of shared decision-making, assessed using study-specific custom questions (e.g. "I appreciate the Consultation Support Tool for shared decision-making." (question originally asked in French), with answer options according to a 5-point Likert scale; higher scores indicate better outcomes).

    Measured: Baseline and after 6 months.

  9. Perceived appropriateness of the CRP flowchart

    Perceived appropriateness of the CRP flowchart, measured using a French translation of "Intervention Appropriateness Measure" (5-point Likert scale, higher score means better outcome).

    Measured: Baseline and after 6 months.

  10. Perceived appropriateness of the CRP flowchart assessed by custom questions

    Perceived appropriateness of the CRP flowchart, assessed using study-specific custom questions (e.g. "The CRP decision tree corresponds to the patient population in my practice/medical center." (question originally asked in French), with answer options according to a 5-point Likert scale, higher scores indicate better outcomes).

    Measured: Baseline and after 6 months.

  11. Perceived appropriateness of shared decision-making

    Perceived appropriateness of shared decision-making, measured using a French translation of "Intervention Appropriateness Measure" (5-point Likert scale, higher score means better outcome).

    Measured: Baseline and after 6 months.

  12. Perceived appropriateness of shared decision-making assessed by custom questions

    Perceived appropriateness of shared decision-making, assessed using study-specific custom questions (e.g. "Shared decision-making in patients with an acute respiratory infection and a CRP level ≥ 50 mg/L and < 100 mg/L corresponds to the patient population in my practice/medical center." (question originally asked in French), with answer options according to a 5-point Likert scale, higher scores indicate better outcomes).

    Measured: Baseline and after 6 months.

  13. Perceived feasibility of the CRP flowchart

    Perceived feasibility of the CRP flowchart, measured using a French translation of "Feasibility of Intervention Measure" (5-point Likert scale, higher score means better outcome).

    Measured: Baseline and after 6 months.

  14. Perceived feasibility of the CRP flowchart assessed by custom questions

    Perceived feasibility of the CRP flowchart, assessed using study-specific custom questions (e.g. "CRP testing in patients with an acute respiratory infection can be performed within a reasonable timeframe." (question originally asked in French), with answer options according to a 5-point Likert scale, higher scores indicate better outcomes).

    Measured: Baseline and after 6 months.

  15. Perceived feasibility of shared decision-making

    Perceived feasibility of shared decision-making, measured using a French translation of "Feasibility of Intervention Measure" (5-point Likert scale).

    Measured: Baseline and after 6 months.

  16. Perceived feasibility of shared decision-making assessed by custom questions

    Perceived feasibility of shared decision-making, assessed using study-specific custom questions (e.g. "Shared decision-making in patients with an acute respiratory infection and a CRP level ≥ 50 mg/L and < 100 mg/L takes too much time." (question originally asked in French), with answer options according to a 5-point Likert scale, higher scores indicate better outcomes).

    Measured: Baseline and after 6 months.

  17. Intended adoption of acute respiratory infection guidelines

    Intended adoption of the new ARI guideline using custom questions. Intended adoption of the CRP flowchart using custom questions. Intended adoption of shared decision-making using custom questions.

    Measured: Baseline and after 6 months.

  18. Fidelity to C-reactive protein

    Fidelity to the CRP flowchart of the new ARI guidelines, using custom questions.

    Measured: Baseline and after 6 months.

  19. Fidelity to shared decision-making

    Fidelity to shared decision-making of the new ARI guidelines, using custom questions.

    Measured: Baseline and after 6 months.

  20. Anticipated sustainment of acute repiratory infection guidelines

    Anticipated sustainment of the new ARI guidelines, using custom questions.

    Measured: Baseline and after 6 months.

  21. Intended adoption of implementation strategies

    Intended adoption of implementation strategies, measured with custom questions (5-point Likert scale, higher score is higher intention to adopt).

    Measured: Baseline and after 6 months.

  22. Adoption of implementation strategies

    Adoption of implementation strategies, measured with custom questions (single answer, yes/no).

    Measured: Baseline and after 6 months.

  23. Fidelity in delivering the implementation strategies

    Fidelity of delivering the implementation strategies as intended, using custom questions.

    Measured: During the ILI season (6 months).

  24. Acceptability of moderator implementation materials

    Acceptability of implementation materials for moderators, measured with the instrument "Acceptability of Intervention Measure" (5-point Likert scale, higher score means better outcome) and additional custom question(s).

    Measured: During the ILI season (6 months).

  25. Acceptability of physician implementation materials

    Acceptability of implementation materials for physicians, measured with the instrument "Acceptability of Intervention Measure" (5-point Likert scale, higher score means better outcome) and additional custom question(s).

    Measured: During the ILI season (6 months).

  26. Contextual and individual determinants of adoption

    Determinants of adoption of the ARI guidelines identified through quantitative and potentially qualitative data collection.

    Measured: Within 6 months after the ILI season.

Timeline

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

  1. First posted9 Feb 2026
  2. Study start19 May 2025
  3. Primary completion30 Jun 2026 (estimated)
  4. Study completionNov 2026 (estimated)

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
Diagnosis
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
200 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07396428
Sponsor's protocol ID
Req-2024-00897
Other IDs
212429
Acronym
ImpProGUIDE
Status last verified
Jun 2026
First submitted
18 Nov 2025
Last updated
24 Jun 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: The non-identifiable data from the physician and moderator surveys, excluding free-text items, will be shared on the institutional data repository data.unisante.ch under the license CC-BY in open access mode. The ownership of these data will be joint between Unisanté and IFIS. Billing data cannot be shared due to intellectual property rights and restrictions on reuse of the data. Qualitative data from Institute for Implementation Science in Healthcare, University of Zurich (interview data (audio/video files, transcripts)) will not be shared, as the risk of identification remains even after removing names, affiliations and other direct identifiers. Non-identifiable quotes of the interview partner, frequencies of codes, or processed/aggregated data will be shared upon reasonable request. These data will not be stored on a data repository as the effort to process data is not considered in proportion to the likelihood that this data will be requested from other research groups.

Publications

  • Wolfensberger A, Gendolla SC, Dunaiceva J, Pluss-Suard C, Niquille A, Nicolet A, Marti J, Powell BJ, Naef R, Boillat-Blanco N, Mueller Y, Clack L. Systematic method for developing tailored strategies for implementing point-of-care procalcitonin testing to guide antibiotic prescribing in Swiss primary care: a protocol for a mixed-methods participatory approach. BMJ Open. 2025 Mar 5;15(3):e091285. doi: 10.1136/bmjopen-2024-091285.

    PubMed 40044189

Questions about this trial

What is this clinical trial studying?

A study testing Training Session on acute respiratory infection guideline within a multifaceted implementation strategy in people with Acute Respiratory Infection and Influenza-like Illness, run by Center for Primary Care and Public Health (Unisante), University of Lausanne, Switzerland at 1 site in Switzerland.

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 20 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: looking for participants now, as of the sponsor's last update on 24 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Switzerland. 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?

This study is still under way. Results are not available in the source record yet.

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

Contact Jelena Dunaiceva, MPH (+41 78 654 23 74, jelena.dunaiceva@unisante.ch; imppro@unisante.ch), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Defined daily doses of antibiotics commonly used for acute respiratory infections per 1000 consultations (time frame: Over the influenza-like illness (ILI) season (6 months).). The study lists 2 primary outcomes in all. 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 NCT07396428, which also lists 1 linked publication.

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 24 Jun 2026.

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