About the project
To address growing antibiotic resistance, brief interventions are needed to decrease unnecessary prescriptions by general practitioners (GPs). In an England-wide trial, 208 general practices received either usual care or one of two interventions:
- a commitment poster encouraging GPs to pledge prudent prescribing or
- the poster and an answerphone message (APM) directing patients with minor infections to a pharmacist.
To investigate how the interventions were implemented in practice and how they were perceived by GPs.
What we did
In collaboration with the NIHR Health Protection Research Unit (HPRU) in Healthcare Associated Infections and Antimicrobial Resistance, we carried out a mixed-methods process evaluation that involved:
- 140 practices in the two intervention arms completing an online survey to capture experiences of implementing the interventions
- GPs from a purposive sample of practices being interviewed about their views of the interventions.
What we found and why that’s important
Interventions were mainly implemented by practice managers (73%) and were used throughout the trial period (poster: 98%, APM: 96%). Staff reported positive views of both interventions (poster: 75%; APM: 78%) and most believed the APM had a positive effect on prescribing (72%). However, only 46% of respondents believed that the posters had reduced antibiotic prescribing and around a quarter of survey respondents felt the interventions had not influenced their practice.
In interviews, all GPs reported that their practice had made recent efforts to reduce antibiotic prescribing and most believed their practice had average or below average prescribing rates. Most felt posters were aimed only at patients who could not engage with posters as they were in consultation rooms. Only two acknowledged the commitment aspect of the poster and most felt that the posters had not influenced their practice. Nearly all GPs felt the answerphone message was useful but some highlighted potential unintended consequences of the message, raising patient safety issues.
The results showed that interventions were widely rolled out in the participating GP practices. Despite this, engagement with the posters was low and GPs were not aware they were making a pledge to prescribe more prudently. Both interventions failed to influence prescribing rates and would need amendments and further testing to see whether they could be effective when implemented at scale, particularly at national level.
Future research needs to establish whether making a pledge or commitment to a behaviour can change antibiotic prescribing, as this act was not explicit in the current study.
We need to further investigate how successful interventions trialled in one context can be translated to other contexts, particularly developing the intervention materials with input from the target population(s).
Public Health England's Behavioural Insights Team
This process evaluation was carried out between August and November 2016 following the end of the trial testing the two interventions.
Publications Tonkin-Crine S., Schneider, AN, Herd N et al. (2017). ‘Interventions to reduce antibiotic prescribing in general practice: a process evaluation of a randomised-controlled trial’. Symposium presentation at the 31st conference of the European Health Psychology Society, Padua, Italy.