Interventions to reduce antibiotic prescribing in general practice: a process evaluation of a randomised-controlled trial

Abstract

Background: Interventions are needed to decrease unnecessary antibiotic prescribing by general practitioners (GPs) across Europe. A randomised-controlled trial cluster-randomised 212 general practices to receive usual care, one or two interventions: a commitment poster (to support GPs to prescribe prudently), or a commitment poster and an answerphone message (directing patients with minor infections to pharmacists). Here, we describe the qualitative process evaluation of the trial. Methods: GPs from a purposive sample of practices were invited to participate in a semi-structured interview about implementing the interventions in practice. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Findings: Twenty-four GPs completed a telephone interview. GPs described making significant changes to their antibiotic prescribing prior to the start of the trial and many felt they were already “low prescribersâ€. Interviews revealed that GPs were divided about the value of the commitment poster; some thought it was a useful, additional tool, while most considered it ineffective for changing their prescribing. The majority had not acknowledged the “commitment†they were making when adding their signatures and photos to posters and many felt posters were aimed only at patients. Nearly all GPs felt the answerphone message was useful for patients, but some highlighted potential unintended consequences and patient safety concerns. Discussion: The views of GPs suggested that key points in the implementation of interventions had been missed which led to differences in how GPs understood and used the interventions. The process evaluation helped to explain why interventions had not influenced prescribing rates.