Influencing antibiotic prescribing by prescriber feedback and management guidelines: a 5-year follow-up

The extent of use of antibiotics for upper respiratory tract infection (URTI) prompted a previous study of an educational intervention based on prescriber feedback and management guidelines. This study demonstrated a reduction in antibiotic prescribing for URTI and a more appropriate choice of antibiotic for tonsillitis/streptococcal pharyngitis. There are few long-term follow-up studies of educational programmes of this kind.

This follow-up study aimed to examine if the reduction in antibiotic prescribing observed in the intervention group of the original study remained present after 5 years, and how the prescribing behaviour of the GPs involved in the follow-up differed from a large national survey of GP prescribing.

Attempts were made to contact the 157 GPs involved in the original study. Of these, 121 were both located and currently working in general practice. Ninety-six consented to take part and, of these, 79 completed a morbidity and treatment survey of 100 patient encounters (response rate 65.3%).

The intervention group (n = 37) maintained their pattern of prescribing of antibiotics for URTI and choice of antibiotic for tonsillitis/streptococcal pharyngitis, with no significant change between the completion of the original study and the 5-year follow-up. The control group (n = 42) showed a downward trend in antibiotic prescribing for URTI, with the effect that no significant differences remained between groups at the 5-year follow-up. At the 5-year follow-up, both groups prescribed significantly fewer antibiotics for URTI and showed greater adherence to prescribing guidelines for tonsillitis/streptococcal pharyngitis than participants in a large national GP survey (n = 984).

This study demonstrated maintenance of prescribing behaviour in the intervention group in the long term. However, the changes in prescribing observed in the control group and the power limitations of the study make it uncertain whether this was the result of a sustained effect of the educational intervention. The differences in both groups from the large national GP survey suggest that other influences on prescribing (such as participation in vocational training for general practice) were also having an important effect.