Abstract
Introduction: Antibiotics are commonly prescribed in primary care for acute respiratory tract complaints (aRTCs), often inappropriately. Social marketing interventions could improve prescribing in such settings. We evaluate the impact of a social marketing intervention on general practitioners’ (GPs’) antibiotic prescribing for aRTCs in Malta. Methods: Changes in GPs’ antibiotic prescribing were monitored over two surveillance periods between 2015 and 2018. Primary outcome: change in antibiotic prescription for aRTCs. Secondary outcomes: change in antibiotic prescription: (i) for immediate use, (ii) for delayed antibiotic prescription, (iii) by diagnosis, and (iv) by antibiotic class. Data were analysed using clustered analysis and interrupted time series analysis (ITSA). Results: Of 33 participating GPs, 18 successfully completed the study. Although clustered analyses showed a significant 3% decrease in overall antibiotic prescription (p = 0.024), ITSA showed no significant change overall (p = 0.264). Antibiotic prescription decreased significantly for the common cold (p < 0.001), otitis media (p = 0.044), and sinusitis (p = 0.004), but increased for pharyngitis (p = 0.015). Conclusions: The intervention resulted in modest improvements in GPs’ antibiotic prescribing. A more top-down approach will likely be required for future initiatives to be successful in this setting, focusing on diagnostic and prescribing support like rapid diagnostic testing, prescribing guidelines, and standardised delayed antibiotic prescriptions.
Highlights
Antibiotics are commonly prescribed in primary care for acute respiratory tract complaints, often inappropriately
In this novel study we show that a Social marketing (SM) intervention can, to some extent, positively change general practitioners’ (GPs)’ antibiotic prescribing for acute respiratory tract complaints (aRTCs)
Our intervention utilised a voluntary behaviour change approach, yet despite being delivered to GPs who were already highly motivated to change, interrupted time series analysis (ITSA) showed no significant impact on their antibiotic prescribing behaviour
Summary
Antibiotics are commonly prescribed in primary care for acute respiratory tract complaints (aRTCs), often inappropriately. We evaluate the impact of a social marketing intervention on general practitioners’ (GPs’) antibiotic prescribing for aRTCs in Malta. Clustered analyses showed a significant 3% decrease in overall antibiotic prescription (p = 0.024), ITSA showed no significant change overall (p = 0.264). Conclusions: The intervention resulted in modest improvements in GPs’ antibiotic prescribing. In Europe, the overall antibiotic consumption trend has been stable, it varies by country, with significantly higher use in southern and eastern European countries [6]. Most antibiotics are prescribed for systemic use in primary care, with respiratory tract infections (RTIs) being the most common diagnoses [7]. Bacterial RTIs are often self-limiting, rendering the effects of antibiotics modest, sometimes negligible [8]. Resistance rates in southern European countries have reached alarming levels [12]
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