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Provision of social-norms feedback to general practices whose antibiotic prescribing is increasing: a national randomized controlled trial

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  • N. Gold
  • M. Ratajczak
  • A. Sallis
  • A. Saei
  • R. Watson
  • P. van Schaik
  • S. Bowen
  • T. Chadborn
<mark>Journal publication date</mark>31/10/2022
<mark>Journal</mark> Journal of Public Health
Issue number10
Number of pages8
Pages (from-to)2351-2358
Publication StatusPublished
Early online date27/12/21
<mark>Original language</mark>English


Aim: The Chief Medical Officer of England writes an annual social-norms-feedback letter to the highest antibiotic-prescribing GP practices. We investigated whether sending a social-norms-feedback letter to practices whose prescribing was increasing would reduce prescribing. Subject and methods: We conducted a two-armed randomised controlled trial amongst practices whose STAR-PU-adjusted prescribing was in the 20th–95th percentiles and had increased by > 4% year-on-year in the 2 previous financial years. Intervention practices received a letter on 1st March 2018 stating ‘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%.’. Control practices received no letter. The primary outcome was the STAR-PU-adjusted rate of antibiotic prescribing in the months from March to September 2018. Results: We randomly assigned 930 practices; ten closed or merged pre-trial, leaving 920 practices — 448 in the intervention and 472 in the control. An autoregressive and moving average model of first order ARMA(1,1) correlation structure showed no effect of the intervention (β <−0.01, z = −0.50, p = 0.565). Prescribing reduced over time in both arms (β <−0.01, z = −36.36, p <0.001). Conclusions: A social-norms-feedback letter to practices whose prescribing was increasing did not decrease prescribing compared to no letter. Trial registration: NCT03582072.