Australia’s new weapon against superbugs and overprescription of antibiotics

There’s a new weapon in the battle against superbugs and overprescribing of antibiotics by GPs — and it couldn’t be any simpler.

The nation’s chief medical officer has written to GPs prescribing the most antibiotics.

Australia has a new weapon in the battle against superbugs and it may be more effective than more costly and complex programs — a carefully crafted letter from the nation’s chief medical officer to the GPs prescribing the most antibiotics.

The Australian has obtained a report from a secret commonwealth trial that found a personally addressed letter from Professor Brendan Murphy, containing the right information, could reduce prescribing rates by almost 15 per cent.

Antibiotic-resistant bacteria are a global problem, causing infections that are harder or impossible to treat, rendering powerful drugs useless and making some surgical procedures higher risk. Superbugs feed off the abuse and misuse of antibiotics — and Australia has one of the highest prescribing rates in the world.

In recent years, the Turnbull government has embraced behavioural economics, using psychological insights to nudge people to make certain decisions. Last June, in the midst of a horror flu season (antibiotics do not work on colds and flu), the government decided to trial such methods on GPs thought to be inappropriately prescribing anti­biotics to patients.

The Department of Health identified 6649 GPs whose antibiotic prescribing rates were in the top 30 per cent for their geographic region. Four different letters were prepared to test different behavioural insights, while a control group of 1338 did not receive a letter, and the chief medical officer was deemed a suitably influential signatory.

The trial found the biggest impact was on the 1333 GPs whose letter from Professor Murphy contained a comparison with their peers as shown in a graphic depicting their scripts as a stack of red and white capsules.

“I know that antimicrobial resistance is a complex issue that requires concerted efforts across general practice, hospitals, laboratories and animal health professionals,” the chief medical officer wrote. “However, there is clear evidence that reducing unnecessary prescribing can lower the incidence of antimicrobial resistance. The benefits of tackling this problem are relevant to every one of our patients.”

The GPs who received that letter reduced their prescribing rate by 12.3 per cent over the next six months, peaking at 14.6 per cent in August last year.

The report of the trial, to be presented to a conference today, suggests peer comparison is a “powerful behavioural tool for policymakers, particularly when using individual-level feedback” and such strategies should be revisited.