Influencing antibiotic prescribing in general practice: a trial of prescriber feedback and management guidelines

Background. The extent of use of antibiotics to treat upper respiratory inf ections in general practice is an area for concern due to the increasing pr oblem of bacterial resistance. Effective educational strategies to promote rational prescribing are needed. Objectives. We aimed to examine the effectiveness of prescriber feedback an d management guidelines in reducing antibiotics prescribing by GP trainees for undifferentiated upper respiratory tract infection, and in improving th e choice of antibiotic for tonsillitis/streptococcal pharyngitis. The resea rch tested a stepwise approach to targeting educational input to high presc ribers. Method. General Practice trainees in New South Wales (n = 157) were randoml y allocated to a treatment group (n = 78) which received an education inter vention on antibiotic use, or to a control group (n = 79) which received an intervention on an unrelated topic. Trainees completed three practice acti vity surveys, each of 110 consecutive patient encounters, with 6-month inte rvals between surveys. Prescriber feedback and management guidelines on use of antibiotics for URTI and choice of antibiotic for tonsillitis/streptoco ccal pharyngitis were delivered in a written form between surveys 1 and 2. An educational outreach visit to high prescribers occurred between surveys 2 and 3. Outcome measures were the rate of antibiotic prescribing for all i ndications, for URTI and prescribing of select antibiotics for tonsillitis/ streptococcal pharyngitis. Results. Antibiotic prescribing by the intervention group declined over thr ee occasions from 25.0 to 23.3 to 19.7 per 100 URTI problems, while the con trol group increased from 22.0 to 25.0 to 31.7 per 100 URTI problems (P = 0 .002). Prescribing in agreement with accepted guidelines for tonsillitis/st reptococcal pharyngitis increased over time in the intervention group from 55.6 to 69.8 to 73.0 per 100 problems, but decreased in the control group f rom 59.6 to 57.5 to 58.5 (P = 0.05). Conclusion. Prescriber feedback and management guidelines were shown to inf luence antibiotic prescribing for URTI and choice of antibiotic for tonsill itis/streptococcal pharyngitis. This study provides a model for targeting e ducational input to those prescribers who most need to change their behavio ur.