Based on the findings from the surveys, we make the following recommendations:
- Use the COM-B model of behaviour when thinking about behaviour change. Using a comprehensive model of behaviour is an extremely useful tool to use when considering influences on behaviour or why a particular behaviour is not engaged in.
- Build on the finding that prescribers take AMR seriously. 97% of prescribers agree that antimicrobial resistance is a challenge that needs to be addressed urgently and 88% agree that they have some personal responsibility for addressing AMR in their practice.
- Consider alternative ways in which to help GPs differentiate between bacterial and viral infections and provide practice-level support for their diagnostic decisions. Almost 70% of prescribers thought it was ‘Important’ or ‘Very Important’ to get refresher training on distinguishing viral from bacterial infections. Prescribers’ opinions were also split into roughly equal thirds of those who said they ‘Agree’, ‘Disagree’, or ‘Neither’ with whether it’s safer to prescribe an antibiotic if they’re not sure if the infection is bacterial or viral. Finding ways to give prescribers better feedback on their clinical decisions – through data or through point-of-care testing devices – may give them more confidence in their decisions.
- Find ways to support prescribers when making diagnostic decisions about the elderly, those in nursing homes, and those with long-term conditions. Prescribers reported being most likely to give an antibiotic to those three groups – even when a viral infection was suspected. We also found that just under half of prescribers never used the app to access the NI Management of Infection Guidelines. We recommend looking at any barriers to accessing all formats of the Guidelines to maximise their benefit.
- Provide timely feedback to prescribers about their performance of antibiotic prescribing relative to their peers, both locally and in the rest of the UK. In the survey, most prescribers believed they prescribe antibiotics less than their peers. We know that providing timely, relevant feedback on behaviour is a good way to change behaviour
- Understand patient behaviour better and manage patient expectations. 62% of prescribers reported feeling that patients expect antibiotics ‘Often’ or ‘Very often’ and just under 70% of prescribers feel they are ‘Sometimes’ or ‘Most of the time’ influenced by that perceived expectation. We also found that, apart from the waiting room, information about appropriate prescribing was very limited in other areas around the practice. Visual cues in the practice such as posters or leaflets could serve as reminders to both patients and prescribers of the value of only taking antibiotics when they are truly needed.
- Develop ways to introduce and mainstream interventions that GPs have confidence in. We found that GPs were unsure about using, for example, delayed prescriptions or point of care testing. If there is good evidence that an intervention changes behaviour, it is important to understand and address barriers to uptake.
- Avoid momentum solutions without a strong evidence base. Although important, we recommend stakeholders temporarily put aside go-to ‘momentum solutions’ such as patient education, and consider alternative possibilities such as the ones outlined above.