Clinical trial NCT03862794: CMO Letter to Reduce Unnecessary Antibiotic Prescribing and Broad Spectrum Prescribing Winter 2018-9
Official title: A Randomized Controlled Trial of Behaviourally Informed Feedback Letters Sent by the Chief Medical Officer on the Amount of Antibiotics and the Percentage of Broad Spectrum Antibiotics Prescribed in Primary Care
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Prescribing, Off-Label
Lead sponsor: Public Health England
Sponsor class: OTHER_GOV
First posted: 2019-03-05
Enrollment: 7000
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: OTHER

Brief summary: This trial aims to reduce unnecessary prescription of antibiotics and broad spectrum antibiotics by general practitioners (GPs) in England. Unnecessary prescriptions are defined as those that do not improve patient health outcomes. The intervention is to send GPs a letter from the Chief Medical Officer (CMO) that gives feedback on their practice's prescribing levels. Specifically the sample was GPs whose practices whose prescribed more than 1.161 items per STAR-PU or whose practices prescribed more that .965 items per STAR-PU and greater than 10% broad spectrum items. The intervention groups received a letter telling them they are among the highest prescribers of either their total or broad spectrum antibiotics, with a graph showing their prescribing compared to average prescribing ("their peers"). The letter also contained a leaflet to help GPs discuss self-care advice with patients and some advice to use delayed prescriptions. The investigators hypothesize that the antibiotic prescribing rate in will be lower for the treatment group compared to the control group, following the receipt of the letter.


Eligibility criteria: Inclusion Criteria:

* GP practices that prescribed more than 1.161 Antibacterial Items/STAR-PU for the twelve months (June 2017 - May 2018)
* GP practices that prescribed more than 0.965 Antibacterial Items/STAR-PU and also more than 10% broad spectrum items for the twelve months (June 2017 - May 2018).

Exclusion Criteria:

* none

Primary outcomes:
measure: total antibiotic prescribing weighted by Specific Therapeutic group Age-sex Related Prescribing Unit (STAR-PU) in November for each GP practice
timeFrame: 1 month
measure: total broad spectrum antibiotic prescribing weighted by STAR-PU in November for each GP practice
timeFrame: 1 month
measure: percentage broad spectrum antibiotic prescribing in November for each GP practice
timeFrame: 1 month
measure: total non-broad spectrum antibiotic prescribing weighted by STAR-PU in November for each GP practice
timeFrame: 1 month
measure: total antibiotic prescribing weighted by STAR-PU in December for each GP practice
timeFrame: 2 months
measure: total broad spectrum antibiotic prescribing weighted by STAR-PU in December for each GP practice
timeFrame: 2 months
measure: percentage broad spectrum antibiotic prescribing in December for each GP practice
timeFrame: 2 months
measure: total non-broad spectrum antibiotic prescribing weighted by STAR-PU in December for each GP practice
timeFrame: 2 months
measure: total antibiotic prescribing in January weighted by STAR-PU for each GP practice
timeFrame: 3 months
measure: total broad spectrum antibiotic prescribing weighted by STAR-PU in January for each GP practice
timeFrame: 3 months
measure: percentage broad spectrum antibiotic prescribing in January for each GP practice
timeFrame: 3 months
measure: total non-broad spectrum antibiotic prescribing weighted by STAR-PU in January for each GP practice
timeFrame: 3 months
measure: total antibiotic prescribing weighted by STAR-PU in February for each GP practice
timeFrame: 4 months
measure: total broad spectrum antibiotic prescribing weighted by STAR-PU in February for each GP practice
timeFrame: 4 months
measure: percentage broad spectrum antibiotic prescribing in February for each GP practice
timeFrame: 4 months
measure: total non-broad spectrum antibiotic prescribing weighted by STAR-PU in February for each GP practice
timeFrame: 4 months
measure: total antibiotic prescribing weighted by STAR-PU in March for each GP practice
timeFrame: 5 months
measure: total broad spectrum antibiotic prescribing weighted by STAR-PU in March for each GP practice
timeFrame: 5 months
measure: percentage broad spectrum antibiotic prescribing in March for each GP practice
timeFrame: 5 months
measure: total non-broad spectrum antibiotic prescribing weighted by STAR-PU in March for each GP practice
timeFrame: 5 months
measure: total antibiotic prescribing weighted by STAR-PU in April for each GP practice
timeFrame: 6 months
measure: total broad spectrum antibiotic prescribing weighted by STAR-PU in April for each GP practice
timeFrame: 6 months
measure: percentage broad spectrum antibiotic prescribing in April for each GP practice
timeFrame: 6 months
measure: total non-broad spectrum antibiotic prescribing weighted by STAR-PU in April for each GP practice
timeFrame: 6 months
Secondary outcomes:
Other outcomes:
Locations:
city: London
country: United Kingdom
facility: Public Health England
Study officials:
References:
citation: Gold N, Sallis A, Saei A, Arambepola R, Watson R, Bowen S, Franklin M, Chadborn T. Using text and charts to provide social norm feedback to general practices with high overall and high broad-spectrum antibiotic prescribing: a series of national randomised controlled trials. Trials. 2022 Jun 18;23(1):511. doi: 10.1186/s13063-022-06373-y.