Clinical trial NCT03582072: CMO Letter to Reduce Unnecessary Antibiotic Prescribing March 2018
Official title: Contacting GPs to Reduce Unnecessary Prescriptions of Antibiotics
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Prescribing, Off-Label
Lead sponsor: Public Health England
Sponsor class: OTHER_GOV
First posted: 2018-07-10
Enrollment: 4796
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: 930 practices (this will be the number of datapoints), 478 in the intervention, 452 in the control; letter sent to individual GPS (4796 subjects, as below), 2340 in the intervention, 2456 in the control

practices
Primary purpose: OTHER

Brief summary: This trial aims to reduce unnecessary prescription of 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, GPs in practices whose prescribing has increase by more than 4% over the past year will receive a letter stating that "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%." The letter will also contain 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.

Detailed description: The investigators hypothesize that the antibiotic prescribing rate in will be lower for the treatment group compared to the control group; the statistical analysis will compare prescribing in March, April, and over the summer (treating May-September as a single data point).

Eligibility criteria: Inclusion Criteria:

* GP practices that increased the number of prescriptions in the financial year 2016/17, compared to the baseline of financial year 2015/16, by 4% or more

Exclusion Criteria:

* GP practices are excluded if their current level of prescription (doses per 1000 head of population) is classed as an outlier. The cut off for outliers is made at the 95th percentile of the distribution.
* Practices that have not been open since at least October 2013 will be excluded. This is because they will lack the historical data necessary to apply a control for seasonal effects to the main outcome variable.
* practices whose antibiotic prescribing rate is in the top 20% for their National Health Service (NHS) Local Area, controlling for relevant patient characteristics.

Primary outcomes:
measure: antibiotic prescribing in March
timeFrame: 1 month
measure: antibiotic prescribing in April
timeFrame: 2 months
measure: antibiotic prescribing May-September
timeFrame: 3-7 months
Secondary outcomes:
Other outcomes:
Locations:
city: London
country: United Kingdom
facility: Public Health England
Study officials:
References: