Antibiotic Prescribing by GPs for URTI
Conditions
Brief summary
1. Do paper-based and web-based intervention modelling experiments (the methodology we are developing) identify the same predictors of GP behaviour regarding prescribing of antibiotics for upper respiratory tract infections? 2. Can a web-based IME system provide trialists with richer and more predictive information upon which to base the development of behavioural change interventions than paper-based IME systems?
Detailed description
The NHS needs effective quality improvement interventions to be put into clinical practice, which requires effective behaviour change interventions. Intervention modelling experiments (IMEs) are a way of exploring and refining an intervention before moving to a full-scale trial. They do this by delivering key elements of the intervention in a simulation that approximates clinical practice by, for example, presenting GPs with a clinical scenario about making a treatment decision. Earlier IMEs have been paper-based, which limits what can be done in the simulation. Web-based IMEs provide the potential for better clinical simulations, which have the potential to lead to better interventions. The current proposal will run a full, web-based IME involving 250 GPs that will advance the methodology of IMEs by directly comparing results with an earlier paper-based IME. Moreover, the web-based IME will evaluate an intervention that can be put into a full-scale trial that aims to reduce antibiotic prescribing in primary care. Reducing inappropriate prescribing of antibiotics in general practice is a national priority; indeed, antibiotic use is increasing in the UK and Scotland's prescribing is second highest amongst UK administrations. More effective behaviour change interventions are needed and this proposal will develop one such intervention and a system to model and test future interventions. This system will be applicable to any situation in the NHS where behaviour needs to be modified, including interventions aimed directly at the public.
Interventions
BEHAVIORALPersuasive communication
The persuasive intervention aimed to reinforce the GP's beliefs about the positive consequences of managing sore throat without prescribing antibiotics.
BEHAVIORALAction plan
This intervention was an action plan, supporting the GP to deal with two difficult prescribing situations: 1) a distressed patient (or often distressed parent of a child patient) 2) a patient demanding an antibiotic
BEHAVIORALGeneral intervention
No additional information was provided; the general information was the information already available to GPs about antibiotic prescribing.
Sponsors
University of Aberdeen
Newcastle University
University of Southampton
Chief Scientist Office of the Scottish Government
Scottish Primary Care Research Network
Scottish School of Primary Care
University of Dundee
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* GPs in Scotland.
Exclusion criteria
* Unable to obtain both an email address and a postal address for the GP.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Simulated Scenarios Where an Antibiotic Was Not Prescribed | Immediately after completion of questionnaire | Eight simulated clinical scenarios where presented to the GP and he/she was asked whether an antibiotic should be prescribed. The outcome measures was the number of scenarios where an antibiotic was not prescribed. |
| Email vs Postal Recruitment: Number of GPs Completing the First Questionnaire | 27/1/20111 - 15/5/2011 | GPs were randomly allocated to receive their invitation to take part by email or by post. Outcome measure was proportion of GPs responding by completing the first questionnaire |
Countries
United Kingdom
Participant flow
Recruitment details
For email vs postal study, 880 physicians received email and 880 received postal invitations. 138 and 132 responded respectively. Other recruitment data presented below are for the main trial component, which involved a subset of the 270 (ie. 138+132) responding to the initial invitation. See arm descriptions for further explanation.
Pre-assignment details
Note this study has two parts: 1) an email vs postal invitation study (with 270 enrolled) and 2) a trial involving a subset (172) of those involved in the email vs postal invitation study. The trial enrolled 198 participants in total, with 26 participants not being involved in the email study. See arm descriptions for further explanations.
Participants by arm
| Arm | Count |
|---|---|
| Persuasive Communication The persuasive intervention aimed to reinforce the GP's beliefs about the positive consequences of managing sore throat without prescribing antibiotics. | 63 |
| Alternative Intervention Action Plan. The work linking simulated prescribing behaviour to predictors of that behaviour suggested that an action plan, detailing situations where GPs found it difficult to not prescribe an antibiotic and offering ways in which the GP could avoid prescribing an antibiotic when this was not necessary. | 74 |
| General Information No information beyond the information that GPs already have from guidelines and other diverse sources (ie. usual care) | 61 |
| Total | 198 |
Baseline characteristics
| Characteristic | Persuasive Communication | Alternative Intervention | General Information | Total |
|---|---|---|---|---|
| Age, Customized Years qualified | 22 years STANDARD_DEVIATION 9 | 20 years STANDARD_DEVIATION 9 | 22 years STANDARD_DEVIATION 8 | 21 years STANDARD_DEVIATION 9 |
| Region of Enrollment United Kingdom | 63 participants | 74 participants | 61 participants | 198 participants |
| Sex/Gender, Customized Female | 27 participants | 34 participants | 27 participants | 88 participants |
| Sex/Gender, Customized Male | 35 participants | 36 participants | 32 participants | 103 participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 0 / 0 | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 | 0 / 0 |
Outcome results
Primary
Email vs Postal Recruitment: Number of GPs Completing the First Questionnaire
GPs were randomly allocated to receive their invitation to take part by email or by post. Outcome measure was proportion of GPs responding by completing the first questionnaire
Time frame: 27/1/20111 - 15/5/2011
Population: 880 physicians received email and 880 received postal invitations. 138 and 132 responded respectively.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Persuasive Communication | Email vs Postal Recruitment: Number of GPs Completing the First Questionnaire | 138 participants |
| Alternative Intervention | Email vs Postal Recruitment: Number of GPs Completing the First Questionnaire | 132 participants |
Primary
Number of Simulated Scenarios Where an Antibiotic Was Not Prescribed
Eight simulated clinical scenarios where presented to the GP and he/she was asked whether an antibiotic should be prescribed. The outcome measures was the number of scenarios where an antibiotic was not prescribed.
Time frame: Immediately after completion of questionnaire
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Persuasive Communication | Number of Simulated Scenarios Where an Antibiotic Was Not Prescribed | 5 scenarios | Standard Deviation 1.4 |
| Alternative Intervention | Number of Simulated Scenarios Where an Antibiotic Was Not Prescribed | 5 scenarios | Standard Deviation 1.6 |
| General Information | Number of Simulated Scenarios Where an Antibiotic Was Not Prescribed | 4.2 scenarios | Standard Deviation 1.1 |