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Feedback on GPs' prescribing habits leads reduction in antibiotic overuse

Feedback from an official or high-profile source can substantially reduce the rate at which primary care physicians prescribe antibiotics, for little cost and on a national scale, according to data published in The Lancet.

“An important driver of resistance is the medical use of antibiotics when they are not clinically indicated,” Michael Hallsworth, PhD, director of health and tax at the Behavioral Insights Team, in London, and colleagues wrote. “Primary care is a focus of antibiotic stewardship efforts for several reasons: It accounts for a large proportion of antibiotic prescriptions; its prescribing practices have been linked to increased antimicrobial resistance; and there is extensive variation between practices, which suggests ‘significant scope to improve prescribing.’”

To determine if clinician-focused feedback, in addition to patient-focused interventions, could reduce unnecessary prescriptions of antibiotics by general practitioners in England, the researchers conducted a randomized, 2x2 factorial trial. Using publically available databases, they identified practices in the top 20% for antibiotic prescriptions in their National Health Service (NHS) local area team. In all, 1,581 practices were selected for the study, which were then randomly assigned into one of two groups; 791 in the feedback intervention group, and 790 in the control group.

On Sept. 29, 2014, practitioners in the feedback group received a letter from England’s chief medical officer stating they were prescribing antibiotics at a higher rate than 80% of practices in their local area team. Those in the control group received no communication. The sample was then re-randomized, with 777 practices assigned to a group receiving patient-focused intervention, and 804 in the control group. In December 2014, those in the intervention group were sent information that promoted reducing the use of antibiotics, while the practitioners in the control group received nothing.

According to the researchers, between October 2014 and March 15, after the feedback group had received letters from the chief medical officer, the rate of antibiotic prescriptions given was 126.98 per 1,000 people, compared with 131.25 per 1,000 in the control group. The difference of 4.27 per 1,000 population represented an estimated 73,406 fewer antibiotics dispensed, the researchers said. The patient-focused intervention did not have a significant effect on antibiotic prescribing habits. Practitioners in the intervention group, between December 2014 and March 2015, dispensed 135 antibiotic items per 1,000 population, compared with 133.98 per 1,000 in the control.

“Our results suggest that antimicrobial stewardship programs should consider incorporating primary care prescribing feedback into their activities, if they do not already do so,” Hallsworth and colleagues wrote. “The effects of this feedback might be enhanced by use of social norms, behavioral instruction and credible messenger. Feedback should form part of an overall strategy that also includes more in-depth, complex interventions, because the effect size reported here will not be sufficient to address the policy issue fully.” – by Jason Laday

Disclosure: The authors report no relevant financial disclosures.