Targeting family physicians to decrease unnecessary antibiotic use

Growing numbers of bacteria are becoming resistant to even our strongest antibiotics. The largest contributor to this rise in antibiotic resistance is over and unnecessary use of antibiotics in the agriculture industry and human health. Antibiotics should be spared for only confirmed bacterial infections but instead are often prescribed to combat any infection of unknown origins. The concern with antibiotic resistance is that routine procedures like surgery will be come increasingly difficult due to untreatable bacterial infections. In the UK a stewardship program targeting family doctors was launched with the aim of reducing the prescription of unnecessary antibiotics.

The study focused on family doctors who’s rates for prescribing antibiotics were in the top 20% of their service area and split them into two interventions. The doctors in the first intervention received letters from England’s Chief Medical Officer stating that their practice was prescribing antibiotics at a higher rate that 80% of their peers. The aim of this was to draw attention to their prescribing behaviours in the hope of changing them. The control group of doctors did not receive any form of communication. This continued from October 2014 to March 2015. In the second arm of the study the researchers sent out patient oriented flyers and pamphlets informing them of the risks of using antibiotics unnecessarily. This arm was designed to determine whether targeting the doctors prescribing the antibiotics or the patients taking them was more effective.

In total there were 1581 family doctors recruited into the study, 791 in the intervention group and 790 in the control group. Between October 2014 and March 2015 the doctor directed intervention reduced the rate of antibiotic prescription by ~4% resulting in 73,406 fewer antibiotics being prescribed. When the focus of the intervention was changed to the patients instead of the physicians there was no change in the number of antibiotics prescribed. This suggested that the doctor directed intervention was an effective way of reducing unnecessary antibiotic prescriptions.

The letter sent to the doctors focused on three main points from behavioural science: 1) social norm information about fellow doctors prescribing habits (specific to geographical area), 2) letter was addressed from a high ranking official to increase the credibility of the request, 3) present feasible options for the physicians instead of prescribing antibiotics. These options were to offer patients on self management of their illness, offer a delayed prescription to monitor the progression of the disease, and talk about the issue with other physicians in the practice to get their feedback. This research highlights the importance of targeting the doctors to reduce over-prescription and overuse of antibiotics. This is a small step to hopefully stunting the rise in antibiotic resistance. There still needs to be a concerted effort on the part of agriculture to reduce their use, something that is sure to be more challenging.

Image Credit: Flickr oliver.dodd

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