CMO Letter to Reduce Unnecessary Antibiotic Prescribing March 2018

NCT03582072 | Completed

• 1 other identifier: CMO letter March 2018
• Study Type: interventional
• Target: 4,796
• Locations: 1 country
• Sites: 1

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.

Conditions

Prescribing, Off-Label

Outcome Measures

Primary Outcomes (3)

• antibiotic prescribing in March

  antibiotic prescribing weighted by Specific Therapeutic group Age-sex Related Prescribing Unit (STAR-PU)

  1 month

• antibiotic prescribing in April

  antibiotic prescribing weighted by STAR-PU

  2 months

• antibiotic prescribing May-September

  antibiotic prescribing weighted by STAR-PU

  3-7 months

Study Arms (2)

letter

EXPERIMENTAL

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

Behavioral: letter from the CMO

control

NO INTERVENTION

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

Interventions

letter from the CMO BEHAVIORAL

informed GPs 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%.\*

letter

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• 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

You may not qualify if:

• 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.

Sponsors & Collaborators

• Public Health England: lead

Study Sites (1)

Public Health England

London, SE1, United Kingdom

Location

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: SPONSOR

Model Details: 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

Study Record Dates

• First Submitted: June 27, 2018
• First Posted: July 10, 2018
• Study Start: February 27, 2018
• Primary Completion: December 31, 2018
• Study Completion: December 31, 2018
• Last Updated: March 3, 2020

Record last verified: 2018-04

Data Sharing

• IPD Sharing: Will not share

Locations

GB (1)