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

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.

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Effects of primary care C-reactive protein point-of-care testing on antibiotic prescribing by general practice staff: pragmatic randomised controlled trial, England, 2016 and 2017

Eurosurveillance ◽

10.2807/1560-7917.es.2020.25.44.1900408 ◽

2020 ◽

Vol 25 (44) ◽

Cited By ~ 1

Author(s):

Charlotte Victoria Eley ◽

Anita Sharma ◽

Hazel Lee ◽

Andre Charlett ◽

Rebecca Owens ◽

...

Keyword(s):

Point Of Care ◽

Controlled Trial ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

C Reactive Protein ◽

Acute Cough ◽

Reactive Protein ◽

General Practices ◽

Randomised Controlled ◽

Pragmatic Randomised Controlled Trial

Background C-reactive protein (CRP) testing can be used as a point-of-care test (POCT) to guide antibiotic use for acute cough. Aim We wanted to determine feasibility and effect of introducing CRP POCT in general practices in an area with high antibiotic prescribing for patients with acute cough and to evaluate patients’ views of the test. Methods We used a McNulty–Zelen cluster pragmatic randomised controlled trial design in general practices in Northern England. Eight intervention practices accepted CRP testing and eight control practices maintained usual practice. Data collection included process evaluation, patient questionnaires, practice audit and antibiotic prescribing data. Results Eight practices with over 47,000 patient population undertook 268 CRP tests over 6 months: 78% of patients had a CRP < 20 mg/L, 20% CRP 20–100 mg/L and 2% CRP > 100 mg/L, where 90%, 22% and 100%, respectively, followed National Institute for Health and Care Excellence (NICE) antibiotic prescribing guidance. Patients reported that CRP testing was comfortable (88%), convenient (84%), useful (92%) and explained well (85%). Patients believed CRP POCT aided clinical diagnosis, provided quick results and reduced unnecessary antibiotic use. Intervention practices had an estimated 21% reduction (95% confidence interval: 0.46–1.35) in the odds of prescribing for cough compared with the controls, a non-significant but clinically relevant reduction. Conclusions In routine general practice, CRP POCT use was variable. Non-significant reductions in antibiotic prescribing may reflect small sample size due to non-use of tests. While CRP POCT may be useful, primary care staff need clearer CRP guidance and action planning according to NICE guidance.

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Faculty Opinions recommendation of Effect of a training and educational intervention for physicians and caregivers on antibiotic prescribing for upper respiratory tract infections in children at primary care facilities in rural China: a cluster-randomised controlled trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.732076634.793539403 ◽

2017 ◽

Author(s):

Brian Eley

Keyword(s):

Respiratory Tract Infections ◽

Rural China ◽

Controlled Trial ◽

Cluster Randomised Controlled Trial ◽

Antibiotic Prescribing ◽

Upper Respiratory Tract ◽

Care Facilities ◽

Upper Respiratory ◽

Randomised Controlled ◽

Tract Infections

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Another voice in the crowd: the challenge of changing family planning and child feeding practices through mHealth messaging in rural central India

BMJ Global Health ◽

10.1136/bmjgh-2021-005868 ◽

2021 ◽

Vol 6 (Suppl 5) ◽

pp. e005868

Author(s):

Kerry Scott ◽

Osama Ummer ◽

Aashaka Shinde ◽

Manjula Sharma ◽

Shalini Yadav ◽

...

Keyword(s):

Family Planning ◽

Social Norms ◽

Health Workers ◽

Extended Family ◽

Controlled Trial ◽

Central India ◽

Modern Contraceptive ◽

Child Feeding ◽

Young Child Feeding ◽

Randomised Controlled

IntroductionKilkari is one of the world’s largest mobile phone-based health messaging programmes. Developed by BBC Media Action, it provides weekly stage-based information to pregnant and postpartum women and their families, including on infant and young child feeding (IYCF) and family planning, to compliment the efforts of frontline health workers. The quantitative component of a randomised controlled trial (RCT) in the Indian state of Madhya Pradesh found that exposure to Kilkari increased modern contraceptive uptake but did not change IYCF practices. This qualitative research complements the RCT to explore why these findings may have emerged.MethodsWe used system generated data to identify households within the RCT with very high to medium Kilkari listenership. Mothers (n=29), as well as husbands and extended family members (n=25 interviews/family group discussions) were interviewed about IYCF and family planning, including their reactions to Kilkari’s calls on these topics. Analysis was informed by the theory of reciprocal determinism, which positions behaviour change within the interacting domains of individual attributes, social and environmental determinants, and existing practices.ResultsWhile women who owned and controlled their own phones were the Kilkari listeners, among women who did not own their own phones, it was often their husbands who listened. Spouses did not discuss Kilkari messages. Respondents retained and appreciated Kilkari messages that aligned with their pre-existing worldviews, social norms, and existing practices. However, they overlooked or de-emphasised content that did not. In this way, they reported agreeing with and trusting Kilkari while persisting with practices that went against Kilkari’s recommendations, particularly non-exclusive breastfeeding and inappropriate complementary feeding.ConclusionTo deepen impact, digital direct to beneficiary services need to be complimented by wider communication efforts (e.g., sustained face-to-face, media, community engagement) to change social norms, taking into account the role of socio-environmental, behavioural, and individual determinants.

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Acceptability of a vocational advice service for patients consulting in primary care with musculoskeletal pain: A qualitative exploration of the experiences of general practitioners, vocational advisers and patients

Scandinavian Journal of Public Health ◽

10.1177/1403494817723194 ◽

2017 ◽

Vol 47 (1) ◽

pp. 78-85 ◽

Cited By ~ 2

Author(s):

Tom Sanders ◽

Gwenllian Wynne-Jones ◽

Bie Nio Ong ◽

Majid Artus ◽

Nadine Foster

Keyword(s):

Primary Care ◽

Controlled Trial ◽

Comparative Method ◽

Qualitative Interviews ◽

Cluster Randomised Controlled Trial ◽

Key Factors ◽

Constant Comparative Method ◽

General Practices ◽

Randomised Controlled ◽

Qualitative Exploration

Aims: Using qualitative interviews, this study explored the experiences of GPs, vocational advisers and patients towards a new vocational advice (VA) service in primary care. Methods: This study was nested within the Study of Work and Pain (SWAP) cluster randomised controlled trial. The SWAP trial located a VA service within three general practices in Staffordshire. Interviews took place with 10 GPs 12 months after the introduction of the VA service, four vocational advisers whilst the VA service was running and 20 patients on discharge from the VA service. The data were analysed using the constant comparative method, which is a variation of grounded theory. Results: The key factors determining the acceptability and perceived effectiveness of the VA service from the perspective of the three groups of stakeholders were (1) the timing of referrals to the VA, (2) the perceived lack of patient demand for the service and (3) role uncertainty experienced by VAs. Conclusions: Early vocational intervention may not be appropriate for all musculoskeletal patients with work difficulties. Indeed, many patients felt they did not require the support of a VA, either because they had self-limiting work difficulties and/or already had support mechanisms in place to return to work. Future VA interventions may be better implemented in a targeted way so that appropriate patients are identified with characteristics which can best be addressed by the VA service.

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Documentation-based clinical decision support to improve antibiotic prescribing for acute respiratory infections in primary care: a cluster randomised controlled trial

Journal of Innovation in Health Informatics ◽

10.14236/jhi.v17i4.742 ◽

2009 ◽

Vol 17 (4) ◽

pp. 231-240 ◽

Cited By ~ 6

Author(s):

Jeffrey Linder ◽

Jeffrey Schnipper ◽

Ruslana Tsurikova ◽

Tony Yu ◽

Lynn Volk ◽

...

Keyword(s):

Primary Care ◽

Randomised Controlled Trial ◽

Respiratory Infections ◽

Controlled Trial ◽

Cluster Randomised Controlled Trial ◽

Clinical Decision ◽

Antibiotic Prescribing ◽

Acute Respiratory Infections ◽

Cluster Randomised ◽

Randomised Controlled

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Effect of point-of-care susceptibility testing in general practice on appropriate prescription of antibiotics for patients with uncomplicated urinary tract infection: a diagnostic randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2017-018028 ◽

2017 ◽

Vol 7 (10) ◽

pp. e018028 ◽

Cited By ~ 5

Author(s):

Anne Holm ◽

Gloria Cordoba ◽

Tina Møller Sørensen ◽

Lisbeth Rem Jessen ◽

Niels Frimodt-Møller ◽

...

Keyword(s):

General Practice ◽

Urinary Tract Infection ◽

Susceptibility Testing ◽

Point Of Care ◽

Controlled Trial ◽

Antibiotic Prescribing ◽

Uncomplicated Urinary Tract Infection ◽

First Line ◽

Randomised Controlled ◽

Microbiological Cure

ObjectivesTo investigate the effect of adding point-of-care (POC) susceptibility testing to POC culture on appropriate use of antibiotics as well as clinical and microbiological cure for patients with suspected uncomplicated urinary tract infection (UTI) in general practice.DesignOpen, individually randomised controlled trial.SettingGeneral practice.ParticipantsWomen with suspected uncomplicated UTI, including elderly patients above 65, patients with recurrent UTI and patients with diabetes. The sample size calculation predicted 600 patients were needed.InterventionsFlexicult SSI-Urinary Kit was used for POC culture and susceptibility testing and ID Flexicult was used for POC culture only.Main outcome measuresPrimary outcome: appropriate antibiotic prescribing on the day after consultation defined as either (1) patient with UTI: to prescribe a first-line antibiotic to which the infecting pathogen was susceptible or a second line if a first line could not be used or (2) patient without UTI: not to prescribe an antibiotic. UTI was defined by typical symptoms and significant growth in a reference urine culture performed at one of two external laboratories.Secondary outcomes: clinical cure on day five according to a 7-day symptom diary and microbiological cure on day 14. Logistic regression models taking into account clustering within practices were used for analysis.Results20 general practices recruited 191 patients for culture and susceptibility testing and 172 for culture only. 63% of the patients had UTI and 12% of these were resistant to the most commonly used antibiotic, pivmecillinam. Patients randomised to culture only received significantly more appropriate treatment (OR: 1.44 (95% CI 1.03 to 1.99), p=0.03). There was no significant difference in clinical or microbiological cure.ConclusionsAdding POC susceptibility testing to POC culture did not improve antibiotic prescribing for patients with suspected uncomplicated UTI in general practice. Susceptibility testing should be reserved for patients at high risk of resistance and complications.Trial registration numberNCT02323087; Results.

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