Targeting behavioural factors that contribute to antibiotic resistance
A global and local health threat
Antibiotic resistance has been identified by the World Health Organisation as one of the greatest threats to human health today and requires action from government, health sectors and the community.
Australia is contributing to the problem of antibiotic resistance with one of the highest rates of antibiotic prescribing in the world:
approximately 19 million prescriptions written each year1
ranks number 8 among 29 countries evaluated2
46% of people were dispensed at least 1 course of antibiotics in 20143
Consumer and GP insights
Audience research conducted by NPS MedicineWise identified multiple gaps in knowledge, beliefs and behaviours that are driving inappropriate prescribing and use of antibiotics in Australia.
Parental expectation for antibiotics is an ongoing challenge faced in general practice. Most parents believe that antibiotics are beneficial for childhood respiratory tract infections (RTIs) such colds, coughs, earaches and sore throats. Many parents also equate the duration of common childhood RTIs with the need for antibiotics.4,5 A survey conducted by NPS MedicineWise found that 40% of Australian general practitioners (GPs) would prescribe antibiotics to meet patient expectations.6
Antibiotics are generally not recommended for common RTIs.7–10 Yet analyses of MedicineInsight data showed over 50% of patients with RTIs were unnecessarily prescribed antibiotics in 201511, highlighting the need to manage patient expectation for antibiotics and reinforce guidelines for prescribing in general practice.
NPS MedicineWise national campaign to reduce unnecessary antibiotic prescribing
In 2012, NPS MedicineWise made a commitment to deliver a 5-year public health campaign that achieves the following strategic imperatives:
address the knowledge, beliefs and behavioural factors driving consumer expectation and demand for antibiotics
support GPs in managing consumer expectations for antibiotics through the provision of patient consultation tools that reinforce guidelines-based management of common RTIs
reduce inappropriate prescribing and use of antibiotics for common RTIs and in turn the development of antibiotic resistance.
Phase 1 plan (2013–2016)
Raise general awareness and improve knowledge about antibiotic resistance, resistant bacteria, limitations of antibiotics on cold and flu viruses and appropriate use:
knowledge that bacteria is becoming resistant
awareness that antibiotic resistance is happening now
knowledge that antibiotic resistance can be passed between people
that antibiotics will not speed up recovery from cold and flu
how misuse of antibiotics can lead to antibiotic resistance.
Phase 2 plan (2017)
Provide patient support and education to address key concepts in appropriate RTI symptom management and expectation for antibiotics:
Duration of RTI symptoms
Speed of recovery from RTIs
RTI symptom management without antibiotics
Expectation for antibiotics
Over 5 years the public health campaign was implemented with various behaviour change interventions and key messages across multiple channels:
Patient-mediated educational resources in general practices, pharmacies and communities
General practice resource kits including patient consultation tools
Consumer mass media campaigns including TV, news and public relations
Social media campaigns including educational videos and quizzes
Clinical guidelines and patient education via NPS MedicineWise website
Consumer awareness of antibiotic resistance:
the proportion of consumers who believe antibiotic resistance affects them now increased from 11% in 2015 to 25% in 2017¹².
Changes in GP prescribing and decision making:
16% increase in proportion of GPs who did not prescribe antibiotics to meet patient expectations (p<0.001)12
14% increase in proportion of GPs who discussed the issue of antibiotic resistance with their patients (p<0.001)12
Reduction in prescribing:*
14% total reduction in total dispensed antibiotics prescriptions13†
1.3 million average annual reduction in dispensed antibiotics prescriptions12†
Savings for the Australian health system:
$48.8 million in total Pharmaceutical Benefits Scheme (PBS) cost savings12‡
$12.2 million in annual PBS cost savings12‡
Reducing antibiotic resistance is complex, multifaceted and requires ongoing communication strategies and interventions to address multiple behavioural factors from both the consumer and health professional perspectives.
Weston C et al. Antibiotic use for respiratory tract infections: Formative Research Phase 1. Sydney: National Prescribing Service, February 2011.