Letter to 'nudge' high antibiotic prescribers linked to drop in prescribing

Press/Media: Research


Specialised news outlet report about published study

Period21 May 2019

Media coverage


Media coverage

  • TitleArticle about published study
    Degree of recognitionInternational
    Media name/outletCenter for Infectious Disease Research and Policy
    Media typeWeb
    CountryUnited States
    DescriptionLetter to 'nudge' high antibiotic prescribers linked to drop in prescribing
    A letter sent to the highest antibiotic-prescribing General Practitioners (GPs) in Northern Ireland was tied to a nearly 5% reduction in prescribing in those practices over the course of a year, researchers reported yesterday in the Journal of Antimicrobial Chemotherapy.

    The letter, signed by Northern Ireland's chief medical officer, was sent to 221 GPs in 67 practices in Northern Ireland in October 2017, on the basis of those practices being in the top 20% of highest prescribers by standardized total antibiotic prescribing rate. The idea behind the behavioral intervention was that providing a descriptive social norm feedback "nudge" could get prescribers to change their prescribing practices. A similar intervention conducted in England in 2014 was associated with 3.3% relative reduction in antibiotic prescribing in targeted practices.

    The outcomes measured in the study were the standardized total antibiotic prescribing rates in the four calendar quarters following the intervention (October 2017 through September 2018).

    The greatest change occurred in the first quarter following the intervention, when there was a change of – 25.7 (95% confidence interval [CI], – 42.5 to – 8.8) antibiotic items per 1,000 Specific Therapeutic group Age-sex Related Units (STAR-PU) associated with the intervention. But with each subsequent quarter, the coefficient increased by a diminishing amount, to – 58.7 antibiotic items per 1,000 STAR-PU (95% CI, – 116.7 to – 0.7) after 1 year. In the final three quarters of the intervention, none of the individual quarters showed a significant change in antibiotic prescribing from the pre-intervention period.

    Still, approximately 18,900 fewer antibiotic items were prescribed than if the intervention had not been made, representing a 4.6% reduction in antibiotic prescribing in those practices and a 1% reduction in overall primary care antibiotic prescribing in Northern Ireland.

    The authors of the study conclude, "This intervention is an example of a low-cost, simple behavioural 'nudge' that policymakers can use to effectively meet their goals without introducing new policies or rules."
    PersonsDeclan Bradley