CMO Letter to Reduce Unnecessary Antibiotic Prescribing and Broad Spectrum Prescribing Winter 2018-9

Not Applicable

Completed

• Conditions: Prescribing, Off-Label
• Interventions: Behavioral: standard social norm feedback letter; Behavioral: new social norm feedback letter with bar chart

• Registration Number: NCT03862794
• Lead Sponsor: Public Health England

Brief Summary

This trial aims to reduce unnecessary prescription of antibiotics and broad spectrum antibiotics by general practitioners (GPs) in England. Unnecessary prescriptions are defined as those that do not improve patient health outcomes. The intervention is to send GPs a letter from the Chief Medical Officer (CMO) that gives feedback on their practice's prescribing levels. Specifically the sample was GPs whose practices whose prescribed more than 1.161 items per STAR-PU or whose practices prescribed more that .965 items per STAR-PU and greater than 10% broad spectrum items. The intervention groups received a letter telling them they are among the highest prescribers of either their total or broad spectrum antibiotics, with a graph showing their prescribing compared to average prescribing ("their peers"). The letter also contained a leaflet to help GPs discuss self-care advice with patients and some advice to use delayed prescriptions. The investigators hypothesize that the antibiotic prescribing rate in will be lower for the treatment group compared to the control group, following the receipt of the letter.

Detailed Description

Not available

Study Timeline

• Study Start: 2018-11-01
• Status Verified: 2018-12
• Study First Submitted: 2019-02-27
• Study First Submitted QC: 2019-03-01
• Study First Posted: 2019-03-05
• Primary Completion: 2019-04-30
• Study Completion: 2019-05-30
• Last Update Submitted: 2020-03-02
• Last Update Posted: 2020-03-03

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 7000

Inclusion Criteria

• GP practices that prescribed more than 1.161 Antibacterial Items/STAR-PU for the twelve months (June 2017 - May 2018)
• GP practices that prescribed more than 0.965 Antibacterial Items/STAR-PU and also more than 10% broad spectrum items for the twelve months (June 2017 - May 2018).

Exclusion Criteria

• none

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
high total and high broad spectrum prescribing control	standard social norm feedback letter	standard social norm feedback letter GPs who prescribe more than 1.161 Antibacterial Items/ STAR-PU and more than 10% broad spectrum receive the standard practice overall prescribing letter as a control
moderate total prescribing and high broad spectrum letter	new social norm feedback letter with bar chart	social norm feedback letter with bar chart GPs who prescribe more than 0.965 but less than 1.161 Antibacterial Items/ STAR-PU and more than 10% broad spectrum will receive a letter that has specific information about the percentile they are on for broad spectrum prescribing and a bar chart representing their broad spectrum prescribing compared to the average
high total prescribing control letter	standard social norm feedback letter	standard social norm feedback letter GPs who prescribe more than 1.161 Antibacterial Items/ STAR-PU and less than 10% broad spectrum receive the standard practice overall prescribing letter as a control
high total prescribing only intervention letter	new social norm feedback letter with bar chart	social norm feedback letter with bar chart GPs who prescribe more than 1.161 Antibacterial Items/ STAR-PU and less than 10% broad spectrum receive a letter that has specific information about the percentile they are on for overall prescribing and a bar chart representing their overall prescribing compared to the average
high total and high broad spectrum prescribing letter	new social norm feedback letter with bar chart	social norm feedback letter with bar chart GPs who prescribe more than 1.161 Antibacterial Items/ STAR-PU and more than 10% broad spectrum receive a letter that has specific information about the percentile they are on for broad spectrum prescribing and a bar chart representing their broad spectrum prescribing compared to the average

Primary Outcome Measures

Name	Time	Method
total antibiotic prescribing weighted by Specific Therapeutic group Age-sex Related Prescribing Unit (STAR-PU) in November for each GP practice	1 month	antibiotic prescribing weighted by Specific Therapeutic group Age-sex Related Prescribing Unit (STAR-PU)
total non-broad spectrum antibiotic prescribing weighted by STAR-PU in December for each GP practice	2 months
percentage broad spectrum antibiotic prescribing in January for each GP practice	3 months
total broad spectrum antibiotic prescribing weighted by STAR-PU in November for each GP practice	1 month	broad spectrum antibiotic prescribing weighted by Specific Therapeutic group Age-sex Related Prescribing Unit (STAR-PU)
percentage broad spectrum antibiotic prescribing in November for each GP practice	1 month	percentage broad spectrum antibiotic prescribing
total non-broad spectrum antibiotic prescribing weighted by STAR-PU in November for each GP practice	1 month	total overall antibiotic prescribing minus total broad spectrum antibiotic prescribing
total antibiotic prescribing weighted by STAR-PU in December for each GP practice	2 months	antibiotic prescribing weighted by Specific Therapeutic group Age-sex Related Prescribing Unit (STAR-PU)
total broad spectrum antibiotic prescribing weighted by STAR-PU in December for each GP practice	2 months
total broad spectrum antibiotic prescribing weighted by STAR-PU in February for each GP practice	4 months
percentage broad spectrum antibiotic prescribing in February for each GP practice	4 months
total antibiotic prescribing weighted by STAR-PU in March for each GP practice	5 months
percentage broad spectrum antibiotic prescribing in December for each GP practice	2 months
total antibiotic prescribing weighted by STAR-PU in February for each GP practice	4 months
total non-broad spectrum antibiotic prescribing weighted by STAR-PU in February for each GP practice	4 months
total broad spectrum antibiotic prescribing weighted by STAR-PU in January for each GP practice	3 months
total antibiotic prescribing in January weighted by STAR-PU for each GP practice	3 months
total non-broad spectrum antibiotic prescribing weighted by STAR-PU in January for each GP practice	3 months
total broad spectrum antibiotic prescribing weighted by STAR-PU in March for each GP practice	5 months
percentage broad spectrum antibiotic prescribing in March for each GP practice	5 months
total non-broad spectrum antibiotic prescribing weighted by STAR-PU in March for each GP practice	5 months
total antibiotic prescribing weighted by STAR-PU in April for each GP practice	6 months
total broad spectrum antibiotic prescribing weighted by STAR-PU in April for each GP practice	6 months
total non-broad spectrum antibiotic prescribing weighted by STAR-PU in April for each GP practice	6 months
percentage broad spectrum antibiotic prescribing in April for each GP practice	6 months

Trial Locations

Locations (1)

Public Health England; 🇬🇧 London, United Kingdom