Clinician-focused feedback effective at reducing unnecessary antibiotic prescriptions among general practitioners

1. This randomized controlled trial showed that a clinician-focused intervention, consisting of a clinician-focused letter and a leaflet from England’s Chief Medical Officer, reduced the rate of antibiotic prescriptions compared to no intervention among general practitioner practices in England.

2. A patient-focused intervention, consisting of patient-focused posters and leaflets, did not significantly change the rate of antibiotic prescriptions compared to no intervention

Evidence Rating Level: 1 (Excellent)

Study Rundown: Increasing antibiotic resistance by microorganisms is a global public health problem. One of the reasons for increased resistance is the unnecessary use of antibiotics when not clinically indicated. This randomized controlled trial sought to reduce the unnecessary prescribing of antibiotics by general practitioner (GP) practices in England through the use of a low-cost feedback intervention. Interventional groups received either clinician or patient-focused communication, while the control groups received no communication.

The results showed that an average of 4.27 less antibiotics were prescribed per 1,000 population by the clinician-focused intervention group than the control group, or a 3.3% relative difference. Antibiotics were also prescribed at a significantly lower rate period in the clinician-focused intervention group during each month of the study compared to the control group. The patient-focused intervention did not significantly change the rate of antibiotic prescription compared to the control group. This study was strengthened by utilizing an effective experimental design, but limited because it did not measure the effects on health outcomes.

Click to read the study in The Lancet

Relevant Reading: Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis

In-Depth [randomized controlled trial]: General practitioner practices in England were randomized to receive one of two interventions in a 2×2 factorial trial design. The first intervention occurred in October 2014. GP practices in the intervention group received a clinician-focused letter and leaflet from England’s Chief Medical Officer, while the control group received no communication. Practices were re-randomized for the second intervention in December 2014. The intervention group received patient-focused posters and leaflets and the control group received no communication. The primary outcome was the rate of antibiotics prescribed per 1,000 weighted population.

1,581 practices were included in the final study, including 791 in the feedback intervention groups and 790 in the control groups. 3,227 letters were sent to GPs in the intervention group. Between October to March 2015, 126.98 antibiotics were dispensed per 1,000 population (95% CI 125.68-128.27) in the clinician-focused intervention group and 131.25 antibiotics (130.33-132.16) in the control group, resulting in an absolute difference of 4.27 (3.3% relative difference) and an incidence rate ratio of 0.967 (95% CI 0.957-0.977; p<0.0001) between groups. 73,406 fewer antibiotics were estimated to be prescribed as a result of the clinician-focused intervention. There was no significant difference in the patient-focused intervention group, with 135.00 antibiotics prescribed per 1,000 population (95% CI 133.77-136.22) in the patient-focused intervention group and 133.98 (133.06-134.90) in the control group, an incidence rate ratio of 1.01 (95% CI 1.00-1.02; p=0.105).

Image: PD

©2016 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.