Multi-stage optimization trial study on improving antibiotic prescriptions in primary medical institutions using Social Norms Feedback (SNF) intervention strategies
Inappropriate use of antibiotics in primary care institutions
Randomisation method: First, simple random sampling was used to select 5 prefecture-level administrative regions from the 9 prefecture-level divisions in Guizhou Province. Next, based on the list provided by the Guizhou Provincial Health Commission, computer-generated random numbers were applied for simple random sampling to recruit 8 primary medical institutions from each of the 5 selected regions, resulting in a total of 40 participating institutions. Finally, a random number table was adopted to randomly allocate the 5 prefecture-level regions into five study arms (Groups A, B, C, D and E), each receiving a distinct combination of intervention strategies. (1) Peer comparison: Regularly send doctors data on their antibiotic prescription rates, irrational prescription rates and their rankings within the institution or administrative region, so as to motivate doctors to voluntarily standardize their prescribing behavior through peer pressure. (2) Real-time alert pop-up windows: When a doctor writes an irrational prescription, a prompt window will pop up in the upper left corner of the computer screen to immediately prevent potential inappropriate medication use. (3) Education and training for medical staff and patients: Conduct online and offline training, and distribute manuals, videos, posters and other materials to improve doctors' ability of rational medication use and patients' awareness, and reduce medication-related demands from patients. (4) Supplementary intervention measures: Appoint dedicated intervention personnel within the institution, display top and underperforming practitioners in feedback reports, and set up appeal channels. These measures strengthen the organizational driving force and operability of the interventions.
Physicians 1. Directly engage in clinical or pharmacy-related work at primary medical institutions 2. Have worked at the aforesaid primary medical institution for more than one year 3. Hold an intermediate or higher professional title 4. Volunteer to participate in this study Patients 1. Patients who have at least one record of receiving antimicrobial drug treatment at the sampled medical institutions during the study period 2. Patients aged 18 years and above 3. Individuals who are fully informed of and willing to cooperate with this study
Physicians 1. Off-duty outpatient doctors and pharmacists 2. Advanced trainees Patients 1. Patients with severe visual and hearing impairments or aphasia 2. Patients who refuse to participate