Developing and Evaluating Interventions to Reduce Inappropriate Prescribing of Antibiotics in Primary Care

Not Applicable

Completed

Conditions: Antibiotic Prescribing by GPs for URTI

Interventions: Behavioral: Action plan
Behavioral: Persuasive communication
Behavioral: General intervention

Registration Number: NCT01206738

Lead Sponsor: University of Dundee

Brief Summary: 1. Do paper-based and web-based intervention modelling experiments (the methodology we are developing) identify the same predictors of GP behaviour regarding prescribing of antibiotics for upper respiratory tract infections?

2. Can a web-based IME system provide trialists with richer and more predictive information upon which to base the development of behavioural change interventions than paper-based IME systems?

Detailed Description: The NHS needs effective quality improvement interventions to be put into clinical practice, which requires effective behaviour change interventions. Intervention modelling experiments (IMEs) are a way of exploring and refining an intervention before moving to a full-scale trial. They do this by delivering key elements of the intervention in a simulation that approximates clinical practice by, for example, presenting GPs with a clinical scenario about making a treatment decision. Earlier IMEs have been paper-based, which limits what can be done in the simulation.

Web-based IMEs provide the potential for better clinical simulations, which have the potential to lead to better interventions. The current proposal will run a full, web-based IME involving 250 GPs that will advance the methodology of IMEs by directly comparing results with an earlier paper-based IME. Moreover, the web-based IME will evaluate an intervention that can be put into a full-scale trial that aims to reduce antibiotic prescribing in primary care. Reducing inappropriate prescribing of antibiotics in general practice is a national priority; indeed, antibiotic use is increasing in the UK and Scotland's prescribing is second highest amongst UK administrations. More effective behaviour change interventions are needed and this proposal will develop one such intervention and a system to model and test future interventions. This system will be applicable to any situation in the NHS where behaviour needs to be modified, including interventions aimed directly at the public.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 270

Inclusion Criteria

GPs in Scotland.

Exclusion Criteria

Unable to obtain both an email address and a postal address for the GP.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Alternative intervention	Action plan	This intervention was an action plan, supporting the GP to deal with two difficult prescribing situations: 1) a distressed patient (or often distressed parent of a child patient) 2) a patient demanding an antibiotic
Persuasive communication	Persuasive communication	The persuasive intervention aimed to reinforce the GP's beliefs about the positive consequences of managing sore throat without prescribing antibiotics.
General information	General intervention	No additional information was provided; the general information was the information already available to GPs about antibiotic prescribing.

Primary Outcome Measures

Name	Time	Method
Number of Simulated Scenarios Where an Antibiotic Was Not Prescribed	Immediately after completion of questionnaire	Eight simulated clinical scenarios where presented to the GP and he/she was asked whether an antibiotic should be prescribed. The outcome measures was the number of scenarios where an antibiotic was not prescribed.
Email vs Postal Recruitment: Number of GPs Completing the First Questionnaire	27/1/20111 - 15/5/2011	GPs were randomly allocated to receive their invitation to take part by email or by post. Outcome measure was proportion of GPs responding by completing the first questionnaire

Secondary Outcome Measures