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

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

Research output: Contribution to journalArticlepeer-review

Abstract

Aims
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 20 th -95 th percentiles and had increased by > 4% year-on-year in the two previous financial years. Intervention practices received a letter on 1 st 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; 10 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 ( b = -0.0005 , z = -0.50, p = .565). Prescribing reduced over time in both arms ( b = -0.00220 , 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
Ethics : Health Research Authority, London – Harrow Research Ethics Committee, REC Reference 14/LO/1544
Original languageEnglish
JournalJournal of Public Health
Publication statusAccepted/In press - 31 Aug 2021

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