CMO Letter to Reduce Unnecessary Antibiotic Prescribing March 2018

Public Health England

Status: Completed

Conditions: Prescribing, Off-Label

Treatments: Behavioral: letter from the CMO

Study type: Interventional

Funder types: Other

Identifiers

NCT03582072

CMO letter March 2018

Details and patient eligibility

About

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.

Full 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).

Enrollment: 4,796 patients

Sex: All

Volunteers: No Healthy Volunteers

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.

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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4,796 participants in 2 patient groups

letter

Experimental group

Description:

letter from the CMO: practice outside the top 20% of prescribers whose prescribing increased by \> 4%, where GPs in the practice were sent a letter informing them their prescribing had increased

Treatment:

Behavioral: letter from the CMO

control

No Intervention group

Description:

practice outside of the top 20% of prescribers whose prescribing increase by \>4%, GPs were not sent a letter