Developing the content of two behavioural interventions: Using theory-based interventions to promote GP management of upper respiratory tract infection without prescribing antibiotics #1

Hrisos, Susan; Eccles, Martin; Johnston, Marie; Francis, Jill J; Kaner, Eileen; Steen, Nick; Grimshaw, Jeremy

doi:10.1186/1472-6963-8-11

Cited by 46 publications

(67 citation statements)

References 27 publications

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“…Although the study was powered on behavioural intention as the primary outcome (because intention features in both theories on which the intervention was based), the data The study had three strengths: it replicates previous work, it used a randomised design and it had a theoretical rationale for selecting intervention components. The work described here, together with that in a sister paper [12] (where we found that the web-based IME identified 8/10 of the predictors of prescribing behaviour identified in the paper-based IME), have largely reproduced results obtained in an earlier, paper-based IME [10,11], which reassures us that the IME methodology is robust. The randomised design is the best way of running an experiment to test the effectiveness of proposed interventions.…”

Section: Of 21supporting

confidence: 81%

“…The work described here is part of a study to evaluate the IME methodology itself by replicating an earlier, paper-based IME [10,11] and describes a randomised evaluation of two interventions -a persuasive communication used in the paperbased IME and an action plan developed from the predictors described in our earlier publication [12] -against a 'no intervention' comparator. To be reassured, (Table 2).…”

Section: Discussionmentioning

confidence: 99%

“…GPs were also offered a £20 voucher for this stage. These data were used to identify predictors of antibiotic-prescribing behaviour, which replicated work from the earlier paper-based IME [10], as well as to design a new intervention [12]. The clinical content of all eight scenarios, provided by one of the authors (MPE), was such that there were no clear cases for prescribing an antibiotic.…”

Section: Recruitmentmentioning

confidence: 96%

“…The work described here is part of a study to evaluate the IME methodology itself by replicating an earlier, paper-based IME [9][10][11]. Our key research interests were:…”

Section: Introductionmentioning

confidence: 99%

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A primary care Web-based Intervention Modeling Experiment replicated behavior changes seen in earlier paper-based experiment

Treweek

Francis

Bonetti

et al. 2016

Journal of Clinical Epidemiology

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Objectives: Intervention Modelling Experiment (IMEs) are a way of developing and testing behaviour change interventions prior to a trial. We aimed to test this methodology in a web-based IME that replicated the trial component of an earlier, paper-based IME.Study design and setting: Three-arm, web-based randomised evaluation of two interventions (persuasive communication and action plan) and a 'no intervention' comparator. The interventions were designed to reduce the number of antibiotic prescriptions in the management of uncomplicated upper respiratory tract infection.General practitioners (GPs) were invited to complete an online questionnaire and eight clinical scenarios where an antibiotic might be considered.Results: 129 GPs completed the questionnaire. GPs receiving the persuasive communication did not prescribe an antibiotic in 0.70 more scenarios (95% confidence interval = 0.17 to 1.24) than those in the control arm. For the action plan, GPs did not prescribe an antibiotic in 0.63 (95% CI = 0.11 to 1.15) more scenarios than those in the control arm. Unlike the earlier IME, behavioural intention was unaffected by the interventions; this may be due to a smaller sample size than intended. Conclusions:A web-based IME largely replicated the findings of an earlier paperbased study, providing some grounds for confidence in the IME methodology. prescribing behavior . The web-based IME did not replicate findings linked to behavioural intention.• Intervention effects were consistent across different modes of intervention What this adds to what is known• Replication studies are relatively rare. Using different modes of delivery, general practitioners from a different part of the UK and done seven years after the original study, this replication experiment demonstrated that the IME methodology can produce consistent results. What is the implication?• The IME methodology may potentially be considered as a way of developing theory-based behaviour change interventions prior to evaluation in a full-scale 8 of 21A CCEPTED MANUSCRIPT trial.

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Section: Of 21supporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Recruitmentmentioning

confidence: 96%

“…The work described here is part of a study to evaluate the IME methodology itself by replicating an earlier, paper-based IME [9][10][11]. Our key research interests were:…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A primary care Web-based Intervention Modeling Experiment replicated behavior changes seen in earlier paper-based experiment

Treweek

Francis

Bonetti

et al. 2016

Journal of Clinical Epidemiology

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“…In addition, an intervention modeling process has been developed that uses setting-specific behavioral theories for selecting interventions. 59 In future studies, such an approach may improve the likelihood of successful interventions. Detailed studies directed at understanding the differences among endoscopists and endoscopy environments, which include nurses, endoscopy volume, and other factors, may be helpful in identifying and developing performance-related interventions for improving adenoma detection rates.…”

Section: Discussionmentioning

confidence: 98%

Can we improve adenoma detection rates? A systematic review of intervention studies

Corley

Jensen

Marks

2011

Gastrointestinal Endoscopy

114

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Effect of Antibiotic-Prescribing Feedback to High-Volume Primary Care Physicians on Number of Antibiotic Prescriptions

et al. 2021

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IMPORTANCE Antibiotic overuse contributes to adverse drug effects, increased costs, and antimicrobial resistance.OBJECTIVE To evaluate peer-comparison audit and feedback to high-prescribing primary care physicians (PCPs) and assess the effect of targeted messaging on avoiding unnecessary antibiotic prescriptions and avoiding long-duration prescribing. DESIGN, SETTING, AND PARTICIPANTSIn this 3-arm randomized clinical trial, administrative data collected from IQVIA's Xponent database were used to recruit the highest quartile of antibiotic-prescribing PCPs (n = 3500) in Ontario, Canada.INTERVENTIONS Physicians were randomized 3:3:1 to receive a mailed letter sent in December 2018 addressing antibiotic treatment initiation (n = 1500), a letter addressing prescribing duration (n = 1500), or no letter (control; n = 500). Outliers at the 99th percentile at baseline for each arm were excluded from analysis. MAIN OUTCOMES AND MEASURESThe primary outcome was total number of antibiotic prescriptions over 12 months postintervention. Secondary outcomes were number of prolonged-duration prescriptions (>7 days) and antibiotic drug costs (in Canadian dollars). Robust Poisson regression controlling for baseline prescriptions was used for analysis. RESULTSOf the 3465 PCPs included in analysis, 2405 (69.4%) were male, and 2116 (61.1%) were 25 or more years from their medical graduation. At baseline, PCPs receiving the antibiotic initiation letter and duration letter prescribed an average of 988 and 1000 antibiotic prescriptions, respectively; at 12 months postintervention, these PCPs prescribed an average of 849 and 851 antibiotic prescriptions, respectively. For the primary outcome of total antibiotic prescriptions 12 months postintervention, there was no statistically significant difference in total antibiotic use between PCPs who received the initiation letter compared with controls (relative risk [RR], 0.96; 97.5% CI, 0.92-1.01; P = .06) and a small statistically significant difference for the duration letter compared with controls (RR, 0.95; 97.5% CI, 0.91-1.00; P = .01). For PCPs receiving the duration letter, this corresponds to an average of 42 fewer antibiotic prescriptions over 12 months. There was no statistically significant difference between the letter arms. For the initiation letter, compared with controls there was an RR of 0.98 (97.5% CI, 0.93-1.03; P = .42) and 0.97 (97.5% CI, 0.92-1.02; P = .19) for the outcomes of prolonged-duration prescriptions and antibiotic drug costs, respectively. At baseline, PCPs who received the duration letter prescribed an average of 332 prolonged-duration prescriptions with $14 470 in drug costs. There was an 8.1% relative reduction (RR, 0.92; 97.5% CI, 0.87-0.97; P < .001) in prolonged-duration prescriptions, and a 6.1% relative reduction in antibiotic drug costs (RR, 0.94; 97.5% CI, 0.89-0.99; P = .01). This corresponds to an average of 24 fewer prolonged-duration prescriptions and $771 in drug cost savings per PCP over 12 months. CONCLUSIONS AND RELEVANCEIn this randomized clinic...

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Developing the content of two behavioural interventions: Using theory-based interventions to promote GP management of upper respiratory tract infection without prescribing antibiotics #1

Cited by 46 publications

References 27 publications

A primary care Web-based Intervention Modeling Experiment replicated behavior changes seen in earlier paper-based experiment

A primary care Web-based Intervention Modeling Experiment replicated behavior changes seen in earlier paper-based experiment

Can we improve adenoma detection rates? A systematic review of intervention studies

Effect of Antibiotic-Prescribing Feedback to High-Volume Primary Care Physicians on Number of Antibiotic Prescriptions

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