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Article

Prescriber Commitment Posters to Increase Prudent Antibiotic Prescribing in English General Practice: A Cluster Randomized Controlled Trial

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Public Health England Behavioural Insights (PHEBI), Research, Translation & Innovation, Public Health England, Wellington House, 133-155 Waterloo Rd, Lambeth, London SE1 8UG, UK
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eHealth Unit, Research Department of Primary Care and Population Health, University College London, London SE1 8UG, UK
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Department of Psychological and Behavioural Science, London School of Economics and Political Sciences, London SE1 8UG, UK
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Nuffield Department of Primary Care Health Sciences University of Oxford, Radcliffe Primary Care, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
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Warwick Business School, University of Warwick, Coventry CV4 7AL, UK
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The Behavioural Insights Team. 4 Matthew Parker St, Westminster, London SW1H 9NP, UK
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NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford OX2 6GG, UK
*
Author to whom correspondence should be addressed.
Antibiotics 2020, 9(8), 490; https://doi.org/10.3390/antibiotics9080490
Received: 4 June 2020 / Revised: 25 June 2020 / Accepted: 1 July 2020 / Published: 7 August 2020
(This article belongs to the Special Issue Antimicrobial Stewardship in Primary Care)
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. View Full-Text
Keywords: primary care; antimicrobial stewardship; antibiotic resistance; commitment posters; antibiotic prescribing primary care; antimicrobial stewardship; antibiotic resistance; commitment posters; antibiotic prescribing
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MDPI and ACS Style

Sallis, A.; Bondaronek, P.; Sanders, J.G.; Yu, L.-M.; Harris, V.; Vlaev, I.; Sanders, M.; Tonkin-Crine, S.; Chadborn, T. Prescriber Commitment Posters to Increase Prudent Antibiotic Prescribing in English General Practice: A Cluster Randomized Controlled Trial. Antibiotics 2020, 9, 490. https://doi.org/10.3390/antibiotics9080490

AMA Style

Sallis A, Bondaronek P, Sanders JG, Yu L-M, Harris V, Vlaev I, Sanders M, Tonkin-Crine S, Chadborn T. Prescriber Commitment Posters to Increase Prudent Antibiotic Prescribing in English General Practice: A Cluster Randomized Controlled Trial. Antibiotics. 2020; 9(8):490. https://doi.org/10.3390/antibiotics9080490

Chicago/Turabian Style

Sallis, Anna, Paulina Bondaronek, Jet G. Sanders, Ly-Mee Yu, Victoria Harris, Ivo Vlaev, Michael Sanders, Sarah Tonkin-Crine, and Tim Chadborn. 2020. "Prescriber Commitment Posters to Increase Prudent Antibiotic Prescribing in English General Practice: A Cluster Randomized Controlled Trial" Antibiotics 9, no. 8: 490. https://doi.org/10.3390/antibiotics9080490

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