Provision of social-norms feedback to general practices whose antibiotic prescribing is increasing: a national randomized controlled trial

Gold, Natalie; Ratajczak, Michael; Sallis, Anna; Saei, Ayoub; Watson, Robin; van Schaik, Paul; Bowen, Sarah; Chadborn, Tim

Abstract

Aim: The Chief Medical Officer of England writes an annual social-norms-feedback letter to the highest antibiotic-prescribing GP practices. We investigated whether sending a social-norms-feedback letter to practices whose prescribing was increasing would reduce prescribing. Subject and methods: We conducted a two-armed randomised controlled trial amongst practices whose STAR-PU-adjusted prescribing was in the 20th–95th percentiles and had increased by > 4% year-on-year in the 2 previous financial years. Intervention practices received a letter on 1st March 2018 stating ‘The great majority (80%) of practices in England reduced or stabilised their antibiotic prescribing rates in 2016/17. However, your practice is in the minority that have increased their prescribing by more than 4%.’. Control practices received no letter. The primary outcome was the STAR-PU-adjusted rate of antibiotic prescribing in the months from March to September 2018. Results: We randomly assigned 930 practices; ten closed or merged pre-trial, leaving 920 practices — 448 in the intervention and 472 in the control. An autoregressive and moving average model of first order ARMA(1,1) correlation structure showed no effect of the intervention (β < −0.01, z = −0.50, p = 0.565). Prescribing reduced over time in both arms (β < −0.01, z = −36.36, p < 0.001). Conclusions: A social-norms-feedback letter to practices whose prescribing was increasing did not decrease prescribing compared to no letter. Trial registration: NCT03582072.

Citation

Gold, N., Ratajczak, M., Sallis, A., Saei, A., Watson, R., van Schaik, P., Bowen, S., & Chadborn, T. (2022). Provision of social-norms feedback to general practices whose antibiotic prescribing is increasing: a national randomized controlled trial. Journal of Public Health, 30, 2351-2358. https://doi.org/10.1007/s10389-021-01645-4

• Journal Article Type: Article
• Acceptance Date: Aug 13, 2021
• Online Publication Date: Dec 27, 2021
• Publication Date: 2022
• Deposit Date: Feb 16, 2022
• Publicly Available Date: Feb 17, 2022
• Journal: Journal of Public Health
• Print ISSN: 0943-1853
• Electronic ISSN: 1613-2238
• Publisher: Springer
• Peer Reviewed: Peer Reviewed
• Volume: 30
• Pages: 2351-2358
• DOI: https://doi.org/10.1007/s10389-021-01645-4
• Public URL: https://durham-repository.worktribe.com/output/1215135