利用文字和图表向总体和广谱抗生素开方率较高的全科医生诊所提供社会规范反馈：一系列全国随机对照试验。

Using text and charts to provide social norm feedback to general practices with high overall and high broad-spectrum antibiotic prescribing: a series of national randomised controlled trials.

机构信息

Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK.

Centre for Philosophy of the Natural and Social Science, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.

出版信息

Trials. 2022 Jun 18;23(1):511. doi: 10.1186/s13063-022-06373-y.

DOI:10.1186/s13063-022-06373-y

PMID:35717262

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9206287/

Abstract

BACKGROUND

Sending a social norms feedback letter to general practitioners who are high prescribers of antibiotics has been shown to reduce antibiotic prescribing. The 2017-9 Quality Premium for primary care in England sets a target for broad-spectrum prescribing, which should be at or below 10% of total antibiotic prescribing. We tested a social norm feedback letter that targeted broad-spectrum prescribing and the addition of a chart to a text-only letter that targeted overall prescribing.

METHODS

We conducted three 2-armed randomised controlled trials, on different groups of practices: Trial A compared a broad-spectrum message and chart to the standard-practice overall prescribing letter (practices whose percentage of broad-spectrum prescribing was above 10% and who had relatively high overall prescribing). Trial C compared a broad-spectrum message and a chart to a no-letter control (practices whose percentage of broad-spectrum prescribing was above 10% and who had relatively moderate overall prescribing). Trial B compared an overall-prescribing message with a chart to the standard practice overall letter (practices whose percentage of broad-spectrum prescribing was below 10% but who had relatively high overall prescribing). Letters were posted to general practitioners, timed to be received on 1 November 2018. The primary outcomes were practices' percentage of broad-spectrum prescribing (trials A and C) and overall antibiotic prescribing (trial B) each month from November 2018 to April 2019 (all weighted by the number and characteristics of patients registered in the practice).

RESULTS

We randomly assigned 1909 practices; 58 closed or merged during the trial, leaving 1851 practices: 385 in trial A, 674 in trial C, and 792 in trial B. AR(1) models showed that there were no statistically significant differences in our primary outcome measures: trial A β = - .199, p = .13; trial C β = .006, p = .95; trial B β = - .0021, p = .81. In all three trials, there were statistically significant time trends, showing that overall antibiotic prescribing and total broad-spectrum prescribing were decreasing.

CONCLUSION

Our broad-spectrum feedback letters had no effect on broad-spectrum prescribing; adding a bar chart to a text-only letter had no effect on overall antibiotic prescribing. Broad-spectrum and overall prescribing were both decreasing over time.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03862794. March 5, 2019.

摘要

背景

向大量开抗生素处方的全科医生发送社会规范反馈信已被证明可以减少抗生素的处方量。2017-9 年英格兰的初级保健质量奖金为广谱处方设定了目标，该目标应低于总抗生素处方的 10%。我们测试了一种针对广谱处方的社会规范反馈信，以及在只包含文字的信中添加图表，以针对总体处方。

方法

我们进行了三项 2 臂随机对照试验，针对不同的实践群体：试验 A 将广谱信息和图表与标准实践总体处方信进行比较（广谱处方百分比高于 10%且总体处方相对较高的实践）。试验 C 将广谱信息和图表与无信对照进行比较（广谱处方百分比高于 10%且总体处方相对适中的实践）。试验 B 将总体处方信息与图表进行比较与标准实践总体信件（广谱处方百分比低于 10%但总体处方相对较高的实践）。信件于 2018 年 11 月寄给全科医生，以在 2018 年 11 月至 2019 年 4 月期间收到。主要结果是从 2018 年 11 月至 2019 年 4 月期间每个月的广谱处方（试验 A 和 C）和总体抗生素处方（试验 B）的百分比，每个实践的数量和特征进行加权。

结果

我们随机分配了 1909 个实践；在试验期间有 58 个关闭或合并，留下 1851 个实践：试验 A 中 385 个，试验 C 中 674 个，试验 B 中 792 个。AR(1)模型显示，我们的主要结果指标没有统计学上的显著差异：试验 Aβ=-.199，p=0.13；试验 Cβ=0.006，p=0.95；试验 Bβ=-.0021，p=0.81。在所有三个试验中，都有统计学上显著的时间趋势，表明总体抗生素处方和总广谱处方都在减少。