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. 2022 Jun 18;23(1):511.
doi: 10.1186/s13063-022-06373-y.

Using text and charts to provide social norm feedback to general practices with high overall and high broad-spectrum antibiotic prescribing: a series of national randomised controlled trials

Natalie Gold  1   2   3 , Anna Sallis  4 , Ayoub Saei  4 , Rohan Arambepola  4   5 , Robin Watson  4   6 , Sarah Bowen  4   7 , Matija Franklin  4   8 , Tim Chadborn  4
Affiliations

Using text and charts to provide social norm feedback to general practices with high overall and high broad-spectrum antibiotic prescribing: a series of national randomised controlled trials

Natalie Gold et al. Trials. .

Abstract

Background: Sending a social norms feedback letter to general practitioners who are high prescribers of antibiotics has been shown to reduce antibiotic prescribing. The 2017-9 Quality Premium for primary care in England sets a target for broad-spectrum prescribing, which should be at or below 10% of total antibiotic prescribing. We tested a social norm feedback letter that targeted broad-spectrum prescribing and the addition of a chart to a text-only letter that targeted overall prescribing.

Methods: We conducted three 2-armed randomised controlled trials, on different groups of practices: Trial A compared a broad-spectrum message and chart to the standard-practice overall prescribing letter (practices whose percentage of broad-spectrum prescribing was above 10% and who had relatively high overall prescribing). Trial C compared a broad-spectrum message and a chart to a no-letter control (practices whose percentage of broad-spectrum prescribing was above 10% and who had relatively moderate overall prescribing). Trial B compared an overall-prescribing message with a chart to the standard practice overall letter (practices whose percentage of broad-spectrum prescribing was below 10% but who had relatively high overall prescribing). Letters were posted to general practitioners, timed to be received on 1 November 2018. The primary outcomes were practices' percentage of broad-spectrum prescribing (trials A and C) and overall antibiotic prescribing (trial B) each month from November 2018 to April 2019 (all weighted by the number and characteristics of patients registered in the practice).

Results: We randomly assigned 1909 practices; 58 closed or merged during the trial, leaving 1851 practices: 385 in trial A, 674 in trial C, and 792 in trial B. AR(1) models showed that there were no statistically significant differences in our primary outcome measures: trial A β = - .199, p = .13; trial C β = .006, p = .95; trial B β = - .0021, p = .81. In all three trials, there were statistically significant time trends, showing that overall antibiotic prescribing and total broad-spectrum prescribing were decreasing.

Conclusion: Our broad-spectrum feedback letters had no effect on broad-spectrum prescribing; adding a bar chart to a text-only letter had no effect on overall antibiotic prescribing. Broad-spectrum and overall prescribing were both decreasing over time.

Trial registration: ClinicalTrials.gov NCT03862794. March 5, 2019.

Keywords: Antibiotics; Antimicrobial resistance; Behavioural intervention; Broad-spectrum prescribing; Data visualisation; Feedback; Messenger effect; Prescribing rates; Primary care; Social norms.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Trial profile
Fig. 2
Fig. 2
Monthly trend of prescribing means over 6 months for broad-spectrum letter vs control letter trial
Fig. 3
Fig. 3
Monthly trend of prescribing mean over 6 months for broad-spectrum letter with chart vs no letter trial
Fig. 4
Fig. 4
Monthly trend of prescribing means over 6 months for overall letter with chart vs control letter trial
See this image and copyright information in PMC

References

    1. O’Neill J. Review on antimicrobial resistance tackling drug-resistant infections globally. 2016.
    1. Public Health England . English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) 2018.
    1. Smieszek T, et al. Potential for reducing inappropriate antibiotic prescribing in English primary care. J Antimicrob Chemother. 2018;73((suppl-2)):ii36–ii43. doi: 10.1093/jac/dkx500. - DOI - PMC - PubMed
    1. Hallsworth M, et al. Provision of social norm feedback to high prescribers of antibiotics in general practice: a pragmatic national randomised controlled trial. The Lancet. 2016;387(10029):1743–1752. doi: 10.1016/S0140-6736(16)00215-4. - DOI - PMC - PubMed
    1. Ratajczak M, et al. The effectiveness of repeating a social norm feedback intervention to high prescribers of antibiotics in general practice: a national regression discontinuity design. J Antimicrob Chemother. 2019;74(12):3603–3610. doi: 10.1093/jac/dkz392. - DOI - PubMed

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