Performance associated effect variations of public reporting in promoting antibiotic prescribing practice: a cluster randomized-controlled trial in primary healthcare settings

Tang, Yongming; Liu, Chenxi; Zhang, Xiaopeng

doi:10.1017/s1463423617000329

Cited by 10 publications

(44 citation statements)

References 40 publications

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“…Public opinion/expectations and peer comparison appear to influence prescribing behaviours but in contrasting ways depending on the disease, patient cohort and doctor’s ranking. Liu et al [58], Tang et al [59], Tang et al [60], and Yang et al [61] reported effects of public reporting in primary care settings in China. Data on antibiotic prescribing (percentage of prescriptions including antibiotics or injections, and cost) were collected and individual doctors and facilities were compared and rankings were published publicly, e.g., on posters outside facilities.…”

Section: Table A1mentioning

confidence: 99%

“…The studies note differences in the effect of public reporting between diseases and age groups according to public perception about appropriateness of prescribing for these categories of illness or people. The intervention also influenced doctors differently according to their ranking, and, in the study by Tang et al [60], doctors categorised as “low prescribers” did not change their habits, even though they could have reduced usage further. These findings indicate that social norms around prescribing are interdependent and must be considered otherwise they can undermine even apparently simple interventions.…”

Section: Table A1mentioning

confidence: 99%

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Interventions to Reduce Antibiotic Prescribing in LMICs: A Scoping Review of Evidence from Human and Animal Health Systems

2018

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This review identifies evidence on supply-side interventions to change the practices of antibiotic prescribers and gatekeepers in low- and middle-income countries (LMICs). A total of 102 studies met the inclusion criteria, of which 70 studies evaluated interventions and 32 provided insight into prescribing contexts. All intervention studies were from human healthcare settings, none were from animal health. Only one context study examined antibiotic use in animal health. The evidence base is uneven, with the strongest evidence on knowledge and stewardship interventions. The review found that multiplex interventions that combine different strategies to influence behaviour tend to have a higher success rate than interventions based on single strategies. Evidence on prescribing contexts highlights interacting influences including health system quality, education, perceptions of patient demand, bureaucratic processes, profit, competition, and cultures of care. Most interventions took place within one health setting. Very few studies targeted interventions across different kinds of providers and settings. Interventions in hospitals were the most commonly evaluated. There is much less evidence on private and informal private providers who play a major role in drug distribution in LMICs. There were no interventions involving drug detailers or the pharmaceutical companies despite their prominent role in the contextual studies.

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Section: Table A1mentioning

confidence: 99%

Section: Table A1mentioning

confidence: 99%

Interventions to Reduce Antibiotic Prescribing in LMICs: A Scoping Review of Evidence from Human and Animal Health Systems

2018

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“…Furthermore, as described earlier, public shaming plays a role in efforts to reduce plastic use. This strategy is more difficult to implement in relation to antibiotic use, particularly due to difficulties in identifying levels of 'inappropriate prescribing', although there is some evidence that public reporting of antibiotic prescribing levels can promote reductions in prescribing [74,75]. A closely related, and less ethically problematic, technique is the use of social norm feedback [76,77].…”

Section: Use Social and Reputational Incentives And Sanctionsmentioning

confidence: 99%

Optimizing antibiotic prescribing: collective approaches to managing a common-pool resource

Tarrant

Colman

Chattoe-Brown

et al. 2019

Clinical Microbiology and Infection

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Background: Antimicrobial resistance (AMR) is one of the greatest threats in 21st century medicine. AMR has been characterized as a social dilemma. A familiar version describes the situation in which a collective resource (in this case, antibiotic efficacy) is exhausted due to over-exploitation. The dilemma arises because individuals are motivated to maximize individual payoffs, although the collective outcome is worse if all act in this way. Objectives: We aim to outline the implications for antimicrobial stewardship of characterizing antibiotic overuse as a social dilemma. Sources: We conducted a narrative review of the literature on interventions to promote the conservation of resources in social dilemmas. Content: The social dilemma of antibiotic over-use is complicated by the lack of visibility and imminence of AMR, a loose coupling between individual actions and the outcome of AMR, and the agency relationships inherent in the prescriber role. We identify seven strategies for shifting prescriber behaviour and promoting a focus on the collectively desirable outcome of conservation of antibiotic efficacy: (1) establish clearly defined boundaries and access rights; (2) raise the visibility and imminence of the problem; (3) enable collective choice arrangements; (4) conduct behaviour-based monitoring; (5) use social and reputational incentives and sanctions; (6) address misalignment of goals and incentives; and (7) provide conflict resolution mechanisms. Implications: We conclude that this theoretic analysis of antibiotic stewardship could make the problem of optimizing antibiotic prescribing more tractable, providing a theory base for intervention development.

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“…General practitioners (GPs) were participants of 31 [32, 36, 38, 40, 41, 43, 45, 49, 51, 55, 56, 58, 59, 61-64, 66, 68, 72, 74, 75, 77, 78, 80-82, 85, 90, 92, 96] intervention studies. Participants in the other 38 studies included: (1) Physicians (n=13) [29,33,35,42,48,52,53,69,84,87,88,91,97] , doctors (n=2) [70,83] , clinicians (n=4) [34,39,60,79] , pharmacists (n=4) [44,58,69,76] and staff (n=2) [46,65] of day-care centers; (2) Family physicians (FPs, n=3) [30,37,95] ;…”

Section: Basic Characteristics Of the Included Studiesmentioning

confidence: 99%

“…A total of 22 RCTs were included in the review, including 1 [70] published in Chinese and 21 [29, 30, 33-35, 37, 38, 40, 45, 48-50, 55-58, 61, 66, 78, 92, 96] in English. The studies involved a total of 1,878,693 prescriptions from 14 countries: China [29,48,50,57,70] , Australia [92] , the United States [34] , England [37,38,40] , Canada [33] , Spain [61] , Norway [55] , Germany [45] , Netherlands [30,49,58] , Singapore [78] , Switzerland [35] , Denmark [96] , France [66] and Belgium [56] (951,960 in the intervention group and 926,733 in the control group). Fifteen [29, 30, 33-35, 37, 38, 40, 45, 48-50, 55-57] studies were designed using cluster sampling and 3 [61,92,96] studies did not use random sampling, which was the main reason for the high risk of bias.…”

Section: Intervention Of Apr Studiesmentioning

confidence: 99%

Effect of unifaceted and multifaceted interventions on antibiotic prescription control for respiratory diseases: a systematic review of randomized controlled trials

Chang

Cui

Yang

et al. 2021

Preprint

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Background The global health system is improperly using antibiotics, particularly in the treatment of respiratory diseases. We aimed to examine the effectiveness of implementing a unifaceted and multifaceted intervention for unreasonable antibiotic prescriptions. Methods Relevant literature published in the databases of Pubmed, Embase, Science Direct, Cochrane Central Register of Controlled Trials (CENTRAL), Chinese Journal Full-text (CNKI) and Wanfang was searched. Data were independently filtered and extracted by two reviewers based on a pre-designed inclusion and exclusion criteria. The Cochrane collaborative bias risk tool was used to evaluate the quality of the included studies. Results A total of 1,074 relevant studies were obtained of which 69 were included in the systematic review. Fifty-nine studies reported positive results, that is, the primary results in the intervention groups were superior to those in the control groups. The remaining 10 studies had negative or partially negative results. In 22 studies the outcome variable was the antibiotic prescription rate with detailed reports of the number of prescriptions being further analyzed, of which 19 involved educational interventions for doctors, including: (1) Online training using email, web pages and webinar, (2) Antibiotic guidelines for information dissemination measures by email, postal or telephone reminder, (3) Training doctors in communication skills, (4) Short-term interactive educational seminars, and (5) Short-term field training sessions. Seventeen studies of interventions for health care workers also included: (6) Regular or irregular assessment/audit of antibiotic prescriptions, (7) Prescription recommendations from experts and peers delivered at a meeting or online, (8) Publicly reporting on doctors' antibiotic usage to patients, hospital administrators, and health authorities, (9) Monitoring/feedback prescribing behavior to general practices by email or poster, and (10) Studies involving patients and their families (n=10). Seventeen studies were rated as having a low risk of bias while five were rated as having a high risk of bias. Conclusion The combination of education, prescription audit, prescription recommendations from experts, public reporting, prescription feedback and patient or family member multifaceted interventions can effectively reduce antibiotic prescription rates in health care institutions. Moreover, adding multifaceted interventions to educational interventions can control antibiotic prescription rates and may be a more reasonable method. Registrations: This systematic review was registered in PROSPERO, registration number: CRD42020192560.

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Performance associated effect variations of public reporting in promoting antibiotic prescribing practice: a cluster randomized-controlled trial in primary healthcare settings

Abstract: Public reporting can positively influence antibiotic prescribing patterns of physicians for URTIs in primary care settings, with reduction in antibiotic and combined antibiotic prescriptions. The reduction was mainly attributed to average and high antibiotic prescribers.

Cited by 10 publications

References 40 publications

Interventions to Reduce Antibiotic Prescribing in LMICs: A Scoping Review of Evidence from Human and Animal Health Systems

Interventions to Reduce Antibiotic Prescribing in LMICs: A Scoping Review of Evidence from Human and Animal Health Systems

Optimizing antibiotic prescribing: collective approaches to managing a common-pool resource

Effect of unifaceted and multifaceted interventions on antibiotic prescription control for respiratory diseases: a systematic review of randomized controlled trials

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