When operating in a group, social psychologists suggest the feelings of responsibility for achieving outcomes can be diffused across group members. In other words, people can “hide in the crowd” (Latane, Williams & Harkins, 1979). When receiving group prescribing information, a GP may believe other GPs in the practice are responsible for the highprescribing levels because each individual’s contribution remains unclear. The GP may also be uncertain about how much to reduce their prescribing if at all. As a result, the – practice’s overall prescribing rate may not reduce as much as expected. To reduce the effect of hiding in a group it is recommended individual contributions are identified and measured against a standard (Karau & Williams, 1993). Targeting feedback at individual GPs rather than groups of GPs provides a potential way to increase individual accountability and the effectiveness of a peer comparison intervention. Overview of our approach We designed and tested the impact of four different letters (and associated materials) on the subsequent antibiotic prescribing rates of Australian GPs. There were five distinctive features of our letter designs. Peer comparison with individual and personalised feedback We personalised the GPs’ feedback by providing individual prescribing trial relative to other GPs in their region (e.g. prescribe more antibiotics than 85 per cent of prescribers in the “You ACT region”). We also gave their actual percentile (e.g. 74th, 91th or 89th percentile). Another recent study seeking to reduce overprescribing of antibiotics used individual peer comparisons, although it differed from our study in other respects (Meeker et al. 2016; see conclusion for further discussion). Targeting the top 30 per cent We targeted GPs across Australia whose antibiotic prescribing rates were in the top 30 per cent of their geographic region. We wanted to test whether the power of peer comparison information would vary depending on a person’s position relative to the average. For example, whether peer comparison would work less effectively for those at the 70th percentile compared to the 90th percentile. More than one letter We compared four different letters and associated materials to see if one approach had a greater impact on prescribing Education-only letter contained standard information about AMR and two National – Prescribing Service (NPS) posters.
When operating in a group, social psychologists suggest the feelings of responsibility for achieving outcomes can be diffused across group members. In other words, people can “hide in the crowd” (Latane, Williams & Harkins, 1979). When receiving group prescribing information, a GP may believe other GPs in the practice are responsible for the highprescribing levels because each individual’s contribution remains unclear. The GP may also be uncertain about how much to reduce their prescribing – if at all. As a result, the practice’s overall prescribing rate may not reduce as much as expected. To reduce the effect of hiding in a group it is recommended individual contributions are identified and measured against a standard (Karau & Williams, 1993). Targeting feedback at individual GPs rather than groups of GPs provides a potential way to increase individual accountability and the effectiveness of a peer comparison intervention. Overview of our approach We designed and tested the impact of four different letters (and associated materials) on the subsequent antibiotic prescribing rates of Australian GPs. There were five distinctive features of our letter designs. Peer comparison with individual and personalised feedback We personalised the GPs’ feedback by providing individual prescribing relative to other GPs in their region (e.g. “You prescribe more antibiotics than 85 per cent of prescribers in the ACT region”). We also gave their actual percentile (e.g. 74th, 91th or 89th percentile). Another recent study seeking to reduce overprescribing of antibiotics used individual peer comparisons, although it differed from our study in other respects (Meeker et al. 2016; see conclusion for further discussion). Targeting the top 30 per cent We targeted GPs across Australia whose antibiotic prescribing rates were in the top 30 per cent of their geographic region. We wanted to test whether the power of peer comparison information would vary depending on a person’s position relative to the average. For example, whether peer comparison would work less effectively for those at the 70th percentile compared to the 90th percentile. More than one letter We compared four different letters and associated materials to see if one approach had a greater impact on prescribing Education-only letter – contained standard information about AMR and two National Prescribing Service (NPS) posters. trial
report-nudge-vs-superbugs.docx