The effectiveness of repeating a social norm feedback intervention to high prescribers of antibiotics in general practice: A national regression discontinuity design

Michael Ratajczak, Natalie Gold*, Simon Hailstone, Tim Chadborn

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

Objectives: Unnecessary antibiotic prescribing contributes to antimicrobial resistance. A randomized controlled trial in 2014-15 showed that a letter from England's Chief Medical Officer (CMO) to high-prescribing GPs, giving feedback about their prescribing relative to the norm, decreased antibiotic prescribing. The CMO sent further feedback letters in succeeding years. We evaluated the effectiveness of the repeated feedback intervention. Methods: Publicly available databases were used to identify GP practices whose antibiotic prescribing was in the top 20% nationally (the intervention group). In April 2017, GPs in every practice in the intervention group (n=1439) were sent a letter from the CMO. The letter stated that, 'the great majority of practices in England prescribe fewer antibiotics per head than yours'. Practices in the control group received no communication (n=5986). We used a regression discontinuity design to evaluate the intervention because assignment to the intervention condition was exogenous, depending on a 'rating variable'. The outcome measure was the average rate of antibiotic items dispensed from April 2017 to September 2017. Results: The GP practices who received the letter changed their prescribing rates by -3.69% (95% CI=-2.29 to -5.10; P<0.001), representing an estimated 124 952 fewer antibiotic items dispensed. The effect is robust to different specifications of the model. Conclusions: Social norm feedback from a high-profile messenger continues to be effective when repeated. It can substantially reduce antibiotic prescribing at low cost and on a national scale. Therefore, it is a worthwhile addition to antimicrobial stewardship programmes.

Original languageEnglish
Pages (from-to)3603-3610
Number of pages8
JournalJournal of Antimicrobial Chemotherapy
Volume74
Issue number12
DOIs
Publication statusPublished - 1 Dec 2019

Bibliographical note

Funding Information:
We thank Professor Dame Sally Davies for her support in this project. Rohan Arambepola and Dr Simon Taylor provided useful comments on the manuscript. The study was funded by Public Health England, where the authors were affiliated when doing this work. No other pharmaceutical company or agency paid for the work. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. The paper was presented at the 14th Annual Meeting of the Society for Behavioural Medicine, Reference 87.

Funding Information:
This work was funded by Public Health England (PHE).

Publisher Copyright:
© 2019 The Author(s).

Fingerprint

Dive into the research topics of 'The effectiveness of repeating a social norm feedback intervention to high prescribers of antibiotics in general practice: A national regression discontinuity design'. Together they form a unique fingerprint.

Cite this