The Effectiveness of Interactive Dashboards to Optimise Antibiotic Prescribing in Primary Care: A Systematic Review

Abstract

Governments and healthcare organisations collect data on antibiotic prescribing (AP) for surveillance. This data can support tools for visualisations and feedback to GPs using dashboards that may prompt a change in prescribing behaviour. The objective of this systematic review was to assess the effectiveness of interactive dashboards to optimise AP in primary care. Six electronic databases were searched for relevant studies up to August 2022. A narrative synthesis of findings was conducted to evaluate the intervention processes and results. Two independent reviewers assessed the relevance, risk of bias and quality of the evidence. A total of ten studies were included (eight RCTs and two non-RCTs). Overall, seven studies showed a slight reduction in AP. However, this reduction in AP when offering a dashboard may not in itself result in reductions but only when combined with educational components, public commitment or behavioural strategies. Only one study recorded dashboard engagement and showed a difference of 10% (95% CI 5% to 15%) between intervention and control. None of the studies reported on the development, pilot or implementation of dashboards or the involvement of stakeholders in design and testing. Interactive dashboards may reduce AP in primary care but most likely only when combined with other educational or behavioural intervention strategies.

Keywords: antibiotic prescribing; clinical audit; dashboard; general practice; primary health care.

Figure 1

Flowchart of studies selection. Source: The PRISMA 2020 statement: an updated guideline for reporting systematic reviews [30].

Figure 2

Forest plot of antibiotic prescribing change outcome in odd ratios. Source: elaborated by the authors with information reported of studies included. E+F: Education plus individualized prescribing feedback dashboard; ARI: Acute Respiratory Infection; ARI Quality Dashboard Use (line segment): intervention physicians who used the ARI Quality Dashboard at least once versus intervention clinicians who did not use it; JITIF: Just-in-Time Information and Feedback; APR: Antibiotic prescription rate; URI: Upper respiratory infection; RTIs: Respiratory tract infections; GTIs: Gastrointestinal tract infections; OR: Odd ratio; CI: confidence interval.

Figure 3

Forest plot of antibiotic prescribing change outcome in percentage of change from baseline (between-group difference). Source: elaborated by the authors with information reported of studies included. PPF: Personalised prescription feedback; BCM: written behaviour change message; HB: health board; A&F: audit and feedback; BSA: Broad spectrum antibiotics (clindamycin, co-amoxiclav, clarithromycin, cefalexin, and cefradine); DDD: defined daily doses; CI: confidence interval. * Hemkens (2017) reported change from Baseline (between-group difference) [28] and Elouafkaoui (2016) reported change from baseline with all percentages standardised using control group baseline mean prescribing rate [25] (see Table S3).

Figure 4

Risk of bias (RoB) summary. Source: elaborated by the authors.