Prescriber commitment posters to increase prudent antibiotic prescribing in english general practice: a cluster randomized controlled trial

Anna Sallis*, Paulina Bondaronek, Jet G. Sanders, Ly Mee Yu, Victoria Harris, Ivo Vlaev, Michael Sanders, Sarah Tonkin-Crine, Tim Chadborn

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    2 Citations (Scopus)

    Abstract

    Unnecessary antibiotic prescribing contributes to Antimicrobial Resistance posing a major public health risk. Estimates suggest as many as half of antibiotics prescribed for respiratory infections may be unnecessary. We conducted a three-armed unblinded cluster randomized controlled trial (ISRCTN trial registry 83322985). Interventions were a commitment poster (CP) advocating safe antibiotic prescribing or a CP plus an antimicrobial stewardship message (AM) on telephone appointment booking lines, tested against a usual care control group. The primary outcome measure was antibiotic item dispensing rates per 1000 population adjusted for practice demographics. The outcome measures for post-hoc analysis were dispensing rates of antibiotics usually prescribed for upper respiratory tract infections and broad spectrum antibiotics. In total, 196 practice units were randomized to usual care (n = 60), CP (n = 66), and CP&AM (n = 70). There was no effect on the overall dispensing rates for either interventions compared to usual care (CP 5.673, 95%CI −9.768 to 21.113, p = 0.458; CP&AM, −12.575, 95%CI −30.726 to 5.576, p = 0.167). Secondary analysis, which included pooling the data into one model, showed a significant effect of the AM (−18.444, 95%CI −32.596 to −4.292, p = 0.012). Fewer penicillins and macrolides were prescribed in the CP&AM intervention compared to usual care (−12.996, 95% CI −34.585 to −4.913, p = 0.018). Commitment posters did not reduce antibiotic prescribing. An automated patient antimicrobial stewardship message showed effects and requires further testing.

    Original languageEnglish
    Article number490
    Pages (from-to)1-14
    Number of pages14
    JournalAntibiotics
    Volume9
    Issue number8
    DOIs
    Publication statusPublished - Aug 2020

    Bibliographical note

    Funding Information:
    Funding: The study was conducted as part of the authors’ usual job roles. PHE paid for the cost of posters. STC received funding from the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford in partnership with PHE [HPRU-2012-10041]. JGS received funding from the Economic and Social Research Council [ES/J500215/1] and the White Rose Doctoral Training Centre in partnership with PHE [A0158422]. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care, or Public Health England.

    Publisher Copyright:
    © 2020 by the authors. Licensee MDPI, Basel, Switzerland.

    Keywords

    • Antibiotic prescribing
    • Antibiotic resistance
    • Antimicrobial stewardship
    • Commitment posters
    • Primary care

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