Improving Our Understanding and Practice of Antibiotic Prescribing: A Study on the Use of Social Norms Feedback Letters in Primary Care

Abstract

In the UK, 81% of all antibiotics are prescribed in primary care. Previous research has shown that a letter from the Chief Medical Officer (CMO) giving social norms feedback to General Practitioners (GPs) whose practices are high prescribers of antibiotics can decrease antibiotic prescribing. The aim of this study was to understand the best way for engaging with GPs to deliver feedback on prescribing behaviour that could be replicated at scale; and explore GP information requirements that would be needed to support prescribing behaviour change. Two workshops were devised utilising a participatory approach. Discussion points were noted and agreed with each group of participants. Minutes of the workshops and observation notes were taken. Data were analysed thematically. Four key themes emerged through the data analysis: (1) Our day-to-day reality, (2) GPs are competitive, (3) Face-to-face support, and (4) Empowerment and engagement. Our findings suggest there is potential for using behavioural science in the form of social norms as part of a range of engagement strategies in reducing antibiotic prescribing within primary care. This should include tailored and localised data with peer-to-peer comparisons.

Keywords: antibiotics; feedback; prescribing behaviour; primary care; social norms.

Figure 1

Example of the first GP feedback letter sent to GP Practices in 2014.

Figure 2

Example 1 of the workshop GP feedback letter with a bar graph in the centre and three key action points boxed to the right of the main text.

Figure 3

Example 2 of the workshop GP feedback letter with headline result in red at the top of the letter and three key action points boxed to the right of the main text.

Figure 4

Example 3 of the workshop GP feedback letter with headline result in red in the middle of the letter and three key action points boxed to the right of the main text.